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Maine rates for HCPCS L1950

Ankle Foot Orthosis Spiral (Institute Of Rehabilitative Medicine Type) Plastic Custom-Fabricated. (Rvsd 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$469.44 / $652.15 / $652.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$955.59 / $1,238.05 / $2,294.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.33 / $535.48 / $535.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.34 / $524.34 / $789.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.77 / $382.77 / $524.34
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$869.91 / $869.91 / $869.91
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$604.96 / $652.15 / $652.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.34 / $697.73 / $1,190.15