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Maine rates for HCPCS L0112

Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$786.79 / $999.05 / $999.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,463.90 / $1,896.62 / $3,515.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$916.09 / $961.33 / $961.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$941.33 / $941.33 / $1,209.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.17 / $687.17 / $941.33
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,332.63 / $1,332.63 / $1,332.63
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$926.77 / $999.05 / $999.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$579.07 / $821.14 / $1,888.35