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Massachusetts rates for HCPCS L5500

Initial, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$767.07 / $767.07 / $767.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$767.07 / $767.07 / $1,295.80
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$940.73 / $2,967.06 / $9,722.68
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$769.04 / $1,219.69 / $1,714.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,863.40 / $2,267.04 / $2,919.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,149.59 / $1,557.71 / $1,557.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$963.22 / $1,015.49 / $1,230.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.15 / $963.22 / $2,064.00
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
$1,421.44 / $1,421.44 / $1,492.51
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$979.37 / $979.37 / $979.37
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,613.87 / $9,722.68 / $9,722.68
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.79 / $938.45 / $1,714.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$769.04 / $1,265.91 / $1,541.50