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Massachusetts rates for HCPCS L3650

Shoulder Orthosis Figure Of Eight Design Abduction Restrainer Prefabricated Off-The-Shelf(Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.40 / $35.40 / $35.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.57 / $36.07 / $48.75
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.71 / $160.41 / $414.11
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.65 / $51.73 / $79.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.01 / $104.64 / $134.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.65 / $74.98 / $113.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $46.87 / $59.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.09 / $46.70 / $81.19
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
$65.61 / $65.61 / $68.89
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.94 / $41.94 / $41.94
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.41 / $414.11 / $414.11
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.19 / $40.43 / $79.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.18 / $87.18 / $87.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.61 / $40.43 / $75.09