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Maine rates for HCPCS L2795

Addition to lower extremity orthosis, knee control, full kneecap

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.76 / $77.47 / $77.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.52 / $147.08 / $272.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.96 / $61.09 / $61.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.81 / $62.81 / $93.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.85 / $45.85 / $62.81
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.34 / $103.34 / $103.34
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.49 / $71.87 / $77.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.45 / $63.68 / $146.44