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Massachusetts rates for HCPCS L4100

Replace leather cuff KAFO, proximal thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $57.54 / $57.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $63.10 / $131.83
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $134.90 / $741.31
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $95.50 / $134.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $77.62 / $234.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $77.62 / $93.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $53.70 / $77.62
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
$117.49 / $117.49 / $177.83
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $134.90 / $741.31
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $102.33 / $147.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.09 / $75.86 / $158.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $74.13 / $117.49