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Massachusetts rates for HCPCS L5150

Knee disarticulation (or through knee), molded socket, external knee joints, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,883.80 / $1,883.80 / $1,883.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,883.80 / $1,885.54 / $3,543.06
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,273.00 / $7,169.04 / $26,694.24
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,102.75 / $3,240.28 / $4,210.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,576.18 / $5,567.46 / $7,169.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,823.19 / $3,825.48 / $3,825.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,493.84 / $3,168.89 / $3,249.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,371.77 / $3,249.00 / $5,990.63
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
$3,490.81 / $3,490.81 / $3,665.35
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,677.85 / $2,677.85 / $2,677.85
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,490.21 / $26,694.24 / $26,694.24
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,752.30 / $2,403.73 / $4,210.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,782.06 / $2,304.65 / $4,210.43