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Massachusetts rates for HCPCS L5230

Above knee (AK), for proximal femoral focal deficiency, constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,093.14 / $2,093.14 / $2,093.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,093.14 / $2,093.14 / $3,802.86
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,125.53 / $6,703.92 / $28,917.53
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,160.10 / $3,510.16 / $4,678.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,084.71 / $6,186.14 / $7,966.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,136.92 / $4,250.58 / $4,250.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,770.97 / $2,853.06 / $3,358.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,082.73 / $2,853.06 / $6,673.50
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
$3,878.73 / $3,878.73 / $4,072.67
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,900.87 / $2,900.87 / $2,900.87
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,685.96 / $28,917.53 / $28,917.53
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,898.24 / $2,560.75 / $4,678.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,157.94 / $2,560.75 / $4,565.92