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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
$1,073.75 / $1,073.75 / $1,073.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,073.75 / $1,073.75 / $1,792.15
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,372.95 / $4,330.28 / $13,221.44
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,059.74 / $1,651.78 / $2,399.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,608.39 / $3,173.41 / $4,086.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,609.21 / $2,180.48 / $2,180.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,421.48 / $1,620.00 / $1,722.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,182.59 / $1,620.00 / $2,903.25
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
$1,989.74 / $1,989.74 / $2,089.23
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,354.49 / $1,354.49 / $1,354.49
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,083.71 / $13,221.44 / $13,221.44
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$959.97 / $1,313.64 / $2,399.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,783.46 / $2,783.46 / $2,783.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,041.48 / $1,313.64 / $2,087.60