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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
$2,089.30 / $2,089.30 / $2,089.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,691.53 / $5,623.41
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $4,897.79 / $28,840.32
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $3,630.78 / $4,897.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $6,165.95 / $8,317.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $4,265.80 / $4,265.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $2,884.03 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $3,162.28
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,168.69 / $6,309.57
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $2,884.03
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $4,897.79 / $28,840.32
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $3,715.35 / $5,370.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $3,467.37 / $6,165.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $3,311.31 / $4,168.69