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Maine rates for HCPCS L2755

Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.47 / $93.24 / $93.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.62 / $177.00 / $328.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.87 / $89.74 / $89.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.85 / $88.85 / $112.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.86 / $64.86 / $88.85
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.36 / $124.36 / $124.36
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.45 / $93.24 / $93.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.09 / $76.63 / $176.22