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Massachusetts rates for HCPCS L6687

Upper extremity addition, frame type socket, below elbow or wrist disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.49 / $302.49 / $302.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.49 / $309.70 / $540.34
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.75 / $1,161.10 / $3,692.36
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.05 / $532.23 / $676.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.45 / $400.45 / $1,189.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.33 / $614.27 / $614.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.45 / $432.60 / $485.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.80 / $432.60 / $802.50
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
$560.54 / $560.54 / $588.57
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.85 / $439.85 / $439.85
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,405.39 / $3,692.36 / $3,692.36
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.14 / $370.06 / $676.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.55 / $287.83 / $520.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.68 / $370.06 / $676.09