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Maine rates for HCPCS L0484

Tlso Triplaner Control Two Piece Rigid Plastic Shell Without Interface Liner With Multiple Straps And Closures Posterior Extends From Sacrococcygeal Junction And Terminates Just Inferior To Scapular Spine Anterior Extends From Symphysis Pubis To Sternal Notch Lateral Strength Is Enhanced By Overlapping Plastic Restricts Gross Trunk Motion In The Sagittal Coronal And Transverse Planes Includes A Carved Plaster Or Cad-Cam Model Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,166.35 / $1,620.32 / $1,620.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,374.23 / $3,076.03 / $5,701.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,247.18 / $1,277.61 / $1,277.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,304.10 / $1,304.10 / $1,962.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$952.00 / $952.00 / $1,304.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,161.35 / $2,161.35 / $2,161.35
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,503.08 / $1,620.32 / $1,620.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$887.84 / $1,331.77 / $3,696.30