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Maine rates for HCPCS L1900

Ankle Foot Orthosis Spring Wire Dorsiflexion Assist Calf Band Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.12 / $217.19 / $217.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.25 / $412.33 / $764.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.10 / $193.94 / $193.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.91 / $189.91 / $263.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.63 / $138.63 / $189.91
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.70 / $289.70 / $289.70
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.48 / $217.19 / $217.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.01 / $178.51 / $495.46