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Massachusetts rates for HCPCS L3221

Orthopedic Footwear Mens Shoe Depth Inlay Each Covered By Medicare. Statute Reference: 1862a8)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.46 / $59.46 / $59.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.92 / $59.46 / $82.30
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.00 / $477.00 / $477.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.80 / $68.43 / $138.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.27 / $217.92 / $280.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.84 / $69.84 / $69.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.99 / $69.84 / $98.63
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
$188.49 / $188.49 / $197.91
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.90 / $146.90 / $146.90
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.08 / $477.00 / $477.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.68 / $67.06 / $138.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.68 / $69.81 / $125.92