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Massachusetts rates for HCPCS L5250

Hip disarticulation, Canadian type; molded socket, hip joint, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $2,951.21 / $2,951.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $3,311.31 / $9,120.11
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $6,918.31 / $39,810.72
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $5,011.87 / $6,918.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,244.36 / $8,709.64 / $11,481.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,365.16 / $5,888.44 / $5,888.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,890.45 / $4,365.16 / $4,677.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $4,365.16
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
$5,888.44 / $5,888.44 / $8,912.51
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $3,981.07 / $3,981.07
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $6,918.31 / $39,810.72
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $5,128.61 / $7,585.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $4,677.35 / $8,511.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $4,570.88 / $5,888.44