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Massachusetts rates for HCPCS L5220

Above Knee Short Prosthesis No Knee Joint (Stubbies) With Articulated Ankle/Foot Dynamically Aligned Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,484.69 / $1,484.69 / $1,484.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,484.69 / $1,484.69 / $2,782.90
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,688.20 / $5,324.58 / $20,966.93
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,651.61 / $2,545.08 / $3,318.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,606.66 / $4,387.91 / $5,650.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,225.06 / $3,015.00 / $3,015.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,965.49 / $2,482.86 / $2,482.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,812.49 / $2,482.86 / $4,449.75
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
$2,751.23 / $2,751.23 / $2,888.79
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,103.30 / $2,103.30 / $2,103.30
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,791.44 / $20,966.93 / $20,966.93
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,376.34 / $1,825.88 / $3,318.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.64 / $2,182.50 / $2,488.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,475.81 / $2,012.89 / $3,318.38