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Massachusetts rates for HCPCS L5856

Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,499.54 / $12,499.54 / $12,499.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,499.54 / $13,034.63 / $22,502.42
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25,595.62 / $76,402.92 / $134,932.92
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,934.33 / $21,042.45 / $27,937.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31,236.52 / $36,941.60 / $47,573.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20,065.72 / $24,047.17 / $24,047.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16,200.25 / $16,200.25 / $16,200.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,826.18 / $16,200.25 / $33,597.00
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
$23,162.50 / $23,162.50 / $24,320.62
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,794.71 / $16,794.71 / $16,794.71
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58,829.77 / $134,932.92 / $134,932.92
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,174.94 / $15,291.98 / $27,937.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34,568.35 / $34,568.35 / $34,568.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,886.49 / $15,339.79 / $27,937.34