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Massachusetts rates for HCPCS L1845

Knee Orthosis Double Upright Thigh And Calf With Adjustable Flexion And Extension Joint (Unicentric Or Polycentric) Medial-Lateral And Rotation Control With Or Without Varus/Valgus Adjustment Prefabricated Item That Has Been Trimmed Bent Molded Assembled Or Otherwise Customized To Fit A Specific Patient By An Individual With Expertise (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$428.69 / $428.69 / $428.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.00 / $476.87 / $993.54
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.87 / $1,561.42 / $4,802.66
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.12 / $707.90 / $958.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,041.39 / $1,266.97 / $1,631.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$642.48 / $707.72 / $707.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$567.52 / $632.51 / $687.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.73 / $627.19 / $1,170.00
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
$794.40 / $794.40 / $834.12
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$570.97 / $570.97 / $570.97
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,048.86 / $4,802.66 / $4,802.66
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.55 / $495.53 / $958.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.35 / $524.47 / $958.15