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Massachusetts rates for HCPCS L5857

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $4,570.88 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,466.84 / $5,128.61 / $9,120.11
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $10,232.93 / $47,863.01
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,677.35 / $7,943.28 / $10,715.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,748.98 / $13,489.63 / $17,782.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,244.36 / $9,120.11 / $9,120.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $6,606.93 / $6,606.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $6,606.93
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
$9,120.11 / $9,120.11 / $13,803.84
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,585.78 / $7,585.78 / $7,585.78
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,772.37 / $10,232.93 / $47,863.01
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,677.35 / $7,943.28 / $11,748.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.41 / $6,918.31 / $12,589.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,365.16 / $6,918.31 / $9,120.11