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Massachusetts rates for HCPCS L5781

Addition To Lower Limb Prosthesis Vacuum Pump Residual Limb Volume Management And Moisture Evacuation System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,059.88 / $2,059.88 / $2,059.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,059.88 / $2,172.55 / $3,751.45
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,218.07 / $12,590.94 / $22,493.11
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,152.71 / $3,502.18 / $4,603.97
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,147.66 / $6,087.84 / $7,839.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,395.79 / $4,183.05 / $4,183.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,886.72 / $2,886.72 / $3,465.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,107.31 / $2,886.72 / $5,599.88
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
$3,817.10 / $3,817.10 / $4,007.96
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,441.78 / $3,441.78 / $3,441.78
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,805.49 / $22,493.11 / $22,493.11
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,841.59 / $2,520.06 / $4,603.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,753.36 / $5,753.36 / $5,753.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,047.55 / $2,520.06 / $4,603.97