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Maine rates for HCPCS L3100

Hallus-Valgus Night Dynamic Splint Prefabricated Off-The-Shelf (Revised 01/01/14) (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.30 / $30.86 / $30.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.22 / $58.58 / $108.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.25 / $29.70 / $29.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.89 / $34.89 / $34.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.47 / $25.47 / $34.89
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.17 / $41.17 / $41.17
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.95 / $30.86 / $30.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.91 / $25.37 / $58.33