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Massachusetts rates for HCPCS L1902

Ankle Orthosis Ankle Gauntlet Or Similiar With Or Without Joints Prefabricated Off-The-Shelf (Revised 01/01/2016)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.27 / $45.27 / $115.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.51 / $54.02 / $125.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.80 / $194.63 / $489.49
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $71.16 / $101.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.96 / $133.77 / $172.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.02 / $94.67 / $133.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.00 / $58.00 / $72.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.34 / $56.94 / $92.50
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
$83.88 / $83.88 / $88.07
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.10 / $44.10 / $50.84
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.84 / $50.84 / $60.44
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$182.56 / $489.49 / $489.49
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.39 / $51.68 / $101.16
Tufts
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.51 / $95.33 / $171.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.46 / $52.70 / $101.16