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Maine rates for HCPCS L0626

Lumbar Orthosis Sagittal Control With Rigid Posterior Panel(S) Posterior Extends From L-1 To L-5 Vertebra Produces Intracavitary Pressure To Reduce Load On The Intervertebral Discs Includes Straps Closures May Include Padding Stays Shoulder Straps Pendulous Abdomen Design Pre- Fabricated Item That Has Been Trimmed Bent Molded Assembled Or Otherwise Customized To Fit A Specific Patient By An Individual With Expertise(Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.82 / $55.63 / $55.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.51 / $105.61 / $195.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.86 / $53.55 / $53.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.60 / $58.60 / $58.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.78 / $42.78 / $58.60
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.20 / $74.20 / $74.20
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.39 / $55.63 / $55.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.48 / $45.73 / $105.15