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Massachusetts rates for HCPCS L5706

Custom shaped protective cover, knee disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $562.34 / $562.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $645.65 / $1,122.02
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,258.93 / $5,754.40
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $977.24 / $1,318.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $1,659.59 / $2,187.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,122.02 / $1,122.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $933.25 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $691.83 / $954.99
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,698.24
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $707.95 / $707.95
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,258.93 / $5,754.40
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $977.24 / $1,445.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.87 / $812.83 / $1,479.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $812.83 / $1,122.02