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Massachusetts rates for HCPCS L5505

Initial, above knee (AK), knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,071.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,230.27 / $2,454.71
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $2,511.89 / $13,182.57
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,778.28 / $2,511.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $3,162.28 / $4,265.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,187.76 / $2,187.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,621.81 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,621.81
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
$2,137.96 / $2,137.96 / $3,235.94
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,348.96
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $2,511.89 / $13,182.57
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,862.09 / $2,754.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.66 / $1,584.89 / $2,818.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,584.89 / $2,137.96