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Massachusetts rates for HCPCS L5701

Replacement Socket Above Knee/Knee Disarticulation Including Attachment Plate Molded To Patient Model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,895.75 / $1,895.75 / $1,895.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,895.75 / $1,895.75 / $3,433.62
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,584.94 / $8,152.93 / $25,846.18
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,035.96 / $3,137.34 / $4,237.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,605.21 / $5,602.76 / $7,215.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,125.21 / $3,647.12 / $3,647.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,509.66 / $2,550.04 / $3,041.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,861.53 / $2,550.04 / $5,325.75
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
$3,512.95 / $3,512.95 / $3,688.60
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,122.42 / $3,122.42 / $3,122.42
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,325.45 / $25,846.18 / $25,846.18
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,696.63 / $2,319.26 / $4,237.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,441.30 / $5,441.30 / $5,441.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,694.85 / $2,319.26 / $4,153.68