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Maine rates for HCPCS L1630

Hip orthosis (HO), abduction control of hip joints, semi-flexible (Von Rosen type), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $123.03 / $389.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $302.00 / $346.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $117.49 / $151.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $186.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $120.23
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $269.15
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $123.03 / $389.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $93.33 / $104.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $125.89 / $223.87