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Massachusetts rates for HCPCS L1900

Ankle Foot Orthosis Spring Wire Dorsiflexion Assist Calf Band Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.34 / $156.34 / $156.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.34 / $156.34 / $212.23
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$283.50 / $818.35 / $1,632.96
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.78 / $270.00 / $349.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.98 / $206.98 / $614.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.31 / $275.83 / $275.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.91 / $206.98 / $250.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.63 / $189.91 / $398.63
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
$289.70 / $289.70 / $304.20
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.47 / $216.47 / $216.47
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$697.83 / $1,632.96 / $1,632.96
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.35 / $178.51 / $349.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.22 / $180.35 / $324.98