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Maine rates for HCPCS L1930

Ankle-foot orthosis (AFO), plastic or other material, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.06 / $186.69 / $186.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$273.55 / $354.41 / $656.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.00 / $170.08 / $170.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.81 / $175.81 / $226.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.34 / $140.05 / $175.81
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.02 / $249.02 / $249.02
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.84 / $173.19 / $186.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.30 / $153.44 / $352.87