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Maryland rates for HCPCS L1990

Ankle Foot Orthosis Double Upright Free Plantar Dorsiflexion Solid Stirrup Calf Band/Cuff (Double Bar Bk Orthosis) Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.53 / $248.30 / $392.56
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.00 / $269.00 / $343.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.79 / $313.79 / $313.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.07 / $229.07 / $313.79
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.53 / $502.18 / $723.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.33 / $250.53 / $399.35
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.85 / $300.85 / $351.53