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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
$2,570.40 / $2,570.40 / $2,570.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,691.53 / $8,128.31
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $6,025.60 / $30,902.95
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $4,265.80 / $6,025.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $7,762.47 / $10,232.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $5,248.07 / $5,248.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $3,548.13 / $4,168.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,630.27 / $2,630.27 / $3,548.13
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
$5,248.07 / $5,248.07 / $7,943.28
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,235.94 / $3,235.94 / $3,235.94
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $6,025.60 / $30,902.95
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $4,466.84 / $6,760.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.89 / $3,630.78 / $6,606.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $3,630.78 / $5,248.07