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Maine rates for HCPCS L0490

Tlso Sagittal-Coronal Control One Piece Rigid Plastic Shell With Overlapping Reinforced Anterior With Multiple Straps And Closures Posterior Extends From Scarococcygeal Junction And Terminates At Or Before The T-9 Vertebra Anterior Extends Fromsymphysis Pubis To Xiphoid Anterior Opening Restricts Gross Trunk Motion In Sagittal And Coronal Planes Prefabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.01 / $201.93 / $201.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.89 / $383.35 / $710.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.44 / $194.29 / $194.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$227.96 / $227.96 / $244.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.41 / $166.41 / $227.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.36 / $269.36 / $269.36
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.32 / $201.93 / $201.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.04 / $187.26 / $381.68