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Massachusetts rates for HCPCS L5972

All Lower Extremity Prostheses Foot Flexible Keel (Revised 01012013)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.45 / $215.45 / $215.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.45 / $215.45 / $365.42
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$304.33 / $945.49 / $2,679.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.16 / $334.69 / $481.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$285.20 / $285.20 / $847.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.17 / $437.50 / $437.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$285.20 / $293.77 / $345.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.45 / $293.77 / $553.88
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
$399.24 / $399.24 / $419.20
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.70 / $289.27 / $289.27
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$969.69 / $2,679.00 / $2,679.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.61 / $263.58 / $481.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.00 / $564.00 / $564.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.03 / $263.58 / $423.00