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Maine rates for HCPCS L1990

Ankle-foot orthosis (AFO), 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
$263.03 / $302.00 / $977.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $758.58 / $870.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $398.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $316.23 / $467.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $229.09 / $316.23
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $562.34 / $660.69
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $380.19 / $977.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $245.47 / $398.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $316.23 / $562.34