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Massachusetts rates for HCPCS L5699

All lower extremity prostheses, shoulder harness

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.49 / $126.49 / $126.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.21 / $126.49 / $174.67
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.18 / $505.40 / $1,417.31
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.60 / $181.63 / $282.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.47 / $167.47 / $497.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.53 / $256.87 / $256.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.47 / $169.96 / $202.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.07 / $124.07 / $285.38
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.40 / $234.40 / $246.12
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.33 / $180.33 / $180.33
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$541.54 / $1,417.31 / $1,417.31
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.65 / $154.75 / $282.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.65 / $162.79 / $246.12