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Maine rates for HCPCS L4205

Repair Of Orthotic Device Labor Component Per 15 Minutes (Special Coverage Instructions Apply. See Mcm: 2100.4)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.00 / $12.00 / $13.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.91 / $33.57 / $62.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.00 / $25.00 / $25.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.22 / $22.22 / $22.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $22.22 / $23.36
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.28 / $23.28 / $23.28
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.00 / $12.00 / $12.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.50 / $14.64 / $32.09