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Maine rates for HCPCS L4090

Replace Metal Bands Kafo-Afo, Calf Or Distal Thigh

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.73 / $71.84 / $71.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.27 / $136.38 / $252.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.97 / $64.92 / $64.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.72 / $66.72 / $86.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.71 / $48.98 / $66.72
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.83 / $95.83 / $95.83
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.64 / $71.84 / $71.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.98 / $61.98 / $61.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.36 / $59.05 / $135.78