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Maine rates for HCPCS L3995

Addition to upper extremity orthosis, sock, fracture or equal, each

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.66 / $29.17 / $29.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.74 / $55.38 / $102.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.33 / $23.54 / $23.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.97 / $29.97 / $35.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $29.97
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $38.90 / $38.90
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.66 / $27.07 / $29.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.39 / $25.67 / $48.06