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Massachusetts rates for HCPCS L5782

Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy-duty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,171.58 / $2,171.58 / $2,171.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,171.58 / $2,290.36 / $3,954.91
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,446.79 / $13,273.67 / $23,712.81
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,269.44 / $3,692.09 / $4,853.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,426.80 / $6,417.96 / $8,265.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,579.93 / $4,409.88 / $4,409.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,294.10 / $3,294.10 / $3,294.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,404.69 / $3,294.10 / $5,903.25
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
$4,024.08 / $4,024.08 / $4,225.28
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,628.40 / $3,628.40 / $3,628.40
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,337.20 / $23,712.81 / $23,712.81
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,941.45 / $2,656.72 / $4,853.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,158.59 / $2,656.72 / $4,853.63