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Maine rates for HCPCS 99455

Work related or medical disability examination by the treating physician that includes: Completion of a medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.43 / $87.43 / $87.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.19 / $87.43 / $125.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.00 / $90.00 / $90.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.70 / $122.40 / $202.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.95 / $87.43 / $125.20