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Massachusetts rates for HCPCS L5210

Above knee (AK), short prosthesis, no knee joint (stubbies), with foot blocks, no ankle joints, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,383.32 / $1,383.32 / $1,383.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,383.32 / $1,427.06 / $2,440.09
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,286.51 / $4,057.65 / $16,880.98
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,426.15 / $2,282.92 / $3,091.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,360.42 / $4,088.33 / $5,265.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,280.46 / $2,809.16 / $2,809.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.89 / $1,831.30 / $2,219.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,328.52 / $1,819.89 / $4,039.50
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
$2,563.40 / $2,563.40 / $2,691.57
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,850.39 / $1,850.39 / $1,850.39
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,073.05 / $16,880.98 / $16,880.98
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,236.74 / $1,692.37 / $3,091.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,776.27 / $1,776.27 / $1,776.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,375.05 / $1,692.37 / $3,091.84