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Massachusetts rates for HCPCS L3901

Wrist Hand Finger Orthosis Dynamic Flexor Hinge Reciprocal Wrist Extension/ Flexion Finger Flexion/Extension Cable Driven Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$774.07 / $774.07 / $774.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$774.07 / $853.48 / $1,299.03
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$818.35 / $2,611.23 / $10,211.21
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.18 / $1,349.00 / $1,730.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,880.39 / $2,287.71 / $2,946.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,160.08 / $1,365.77 / $1,365.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,024.74 / $1,107.01 / $1,242.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$808.12 / $1,107.01 / $2,394.73
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
$1,434.41 / $1,434.41 / $1,506.13
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,226.86 / $1,226.86 / $1,226.86
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,725.78 / $10,211.21 / $10,211.21
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$680.99 / $899.34 / $1,730.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$692.04 / $947.00 / $1,730.10