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Massachusetts rates for HCPCS L5100

Below knee (BK), molded socket, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,465.01 / $1,465.01 / $1,465.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,465.01 / $1,465.01 / $2,427.92
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,800.00 / $5,677.20 / $15,327.35
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,431.54 / $2,240.39 / $3,274.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,558.86 / $4,329.76 / $5,575.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,415.14 / $2,975.05 / $2,975.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,743.07 / $1,937.73 / $2,350.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,272.44 / $1,272.44 / $3,818.25
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
$2,714.77 / $2,714.77 / $2,850.51
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.11 / $2,238.11 / $2,238.11
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,686.19 / $15,327.35 / $15,327.35
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,309.77 / $1,792.31 / $3,274.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,391.68 / $1,792.31 / $3,041.90