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Massachusetts rates for HCPCS L5595

Preparatory, hip disarticulation/hemipelvectomy, pylon, no cover, SACH foot, thermoplastic or equal, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,593.44 / $2,593.44 / $2,593.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,593.44 / $2,593.44 / $3,771.92
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,400.00 / $10,723.60 / $30,607.53
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,453.37 / $3,922.41 / $5,796.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,300.08 / $7,664.78 / $9,870.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,886.71 / $5,266.58 / $5,266.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,433.29 / $3,578.08 / $4,161.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,612.00 / $2,612.00 / $6,412.50
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
$4,805.84 / $4,805.84 / $5,046.13
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,238.46 / $3,238.46 / $3,238.46
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,269.36 / $30,607.53 / $30,607.53
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,318.62 / $3,172.82 / $5,796.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,577.92 / $3,823.86 / $5,335.11