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Maine rates for HCPCS L1907

Ankle orthosis (AO), supramalleolar with straps, with or without interface/pads, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.31 / $401.65 / $401.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.53 / $762.50 / $1,413.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.49 / $386.49 / $396.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.48 / $419.48 / $486.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.22 / $306.22 / $419.48
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.76 / $535.76 / $535.76
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.59 / $401.64 / $401.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.08 / $330.12 / $759.18