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Maine rates for HCPCS L1900

Ankle-foot orthosis (AFO), spring wire, dorsiflexion assist calf band, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $186.21 / $549.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $426.58 / $489.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $186.21 / $239.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $190.55 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $138.04 / $190.55
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $371.54
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $199.53 / $549.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $151.36 / $173.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $186.21 / $323.59