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Maine 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
$278.00 / $386.21 / $386.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$565.91 / $733.19 / $1,359.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.99 / $320.45 / $320.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.79 / $313.79 / $467.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.07 / $229.07 / $313.79
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$515.16 / $515.16 / $515.16
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.27 / $386.21 / $386.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.62 / $317.43 / $729.99