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Maine rates for HCPCS L2128

Knee Ankle Foot Orthosis Fracture Orthosis Femoral Fracture Cast Orthosis Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,125.40 / $1,563.43 / $1,563.43
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.86 / $2,968.03 / $5,501.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.64 / $1,232.76 / $1,232.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,207.09 / $1,207.09 / $1,893.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$881.18 / $881.18 / $1,207.09
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,085.46 / $2,085.46 / $2,085.46
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,450.31 / $1,563.43 / $1,563.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$856.67 / $1,285.01 / $2,955.11