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Massachusetts rates for HCPCS L5920

Addition, endoskeletal system, above knee (AK) or hip disarticulation, alignable system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.00 / $371.00 / $371.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.95 / $371.00 / $497.05
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.00 / $1,292.79 / $3,385.23
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.69 / $600.00 / $829.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$491.14 / $491.14 / $1,458.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.60 / $713.76 / $713.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$397.94 / $491.14 / $595.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.50 / $397.94 / $738.38
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
$687.50 / $687.50 / $721.88
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.77 / $453.77 / $453.77
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,292.79 / $3,385.23 / $3,385.23
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.70 / $453.88 / $829.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.69 / $502.99 / $687.50