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Maine rates for HCPCS L4392

Replacement Soft Interface Material Static Afo

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.24 / $17.53 / $17.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $33.29 / $61.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.39 / $16.13 / $16.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.80 / $15.80 / $21.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.53 / $11.53 / $15.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.39 / $23.39 / $23.39
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.27 / $17.53 / $17.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.72 / $15.55 / $33.15