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Massachusetts rates for HCPCS L2005

Knee Ankle Foot Orthosis Any Material Single Or Double Upright Stance Control Automatic Lock Andswing Phase Release Any Type Activation Includesankle Joint Any Type Custom Fabricated (Revised 010112)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,105.48 / $2,105.48 / $2,105.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,105.48 / $2,279.23 / $3,086.29
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,311.43 / $13,727.08 / $22,996.26
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,991.76 / $3,580.59 / $4,705.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,261.63 / $6,222.62 / $8,013.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,049.09 / $3,714.93 / $3,714.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,756.64 / $2,756.64 / $2,756.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,012.35 / $2,012.35 / $5,723.63
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
$3,901.60 / $3,901.60 / $4,096.68
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.35 / $3,090.35 / $3,090.35
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,022.50 / $22,996.26 / $22,996.26
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,834.10 / $2,404.07 / $4,705.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,865.35 / $2,404.07 / $4,705.89