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Massachusetts rates for HCPCS L5200

Above knee (AK), molded socket, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,196.84 / $2,196.84 / $2,196.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,142.69 / $2,196.84 / $3,304.15
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,363.00 / $7,452.90 / $22,879.56
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,078.19 / $3,218.08 / $4,910.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,336.63 / $6,492.63 / $8,361.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,621.59 / $4,461.18 / $4,461.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,728.17 / $2,908.28 / $3,524.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,991.56 / $1,991.56 / $5,087.25
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
$4,070.90 / $4,070.90 / $4,274.43
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,789.25 / $2,789.25 / $2,789.25
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,908.15 / $22,879.56 / $22,879.56
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,964.04 / $2,687.63 / $4,910.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,978.08 / $2,687.63 / $4,070.90