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Massachusetts rates for HCPCS L1990

Ankle-foot orthosis (AFO), double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'BK' orthosis), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $275.42 / $275.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $275.42 / $741.31
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $645.65 / $3,162.28
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $457.09 / $645.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $831.76 / $1,096.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $489.78 / $489.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $371.54 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $229.09 / $346.74
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
$562.34 / $562.34 / $851.14
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $380.19 / $380.19
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $645.65 / $3,162.28
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $478.63 / $645.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.40 / $331.13 / $676.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $338.84 / $562.34