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Maine rates for HCPCS L0636

Lumbar Sacral Orthosis Sagittal-Coronal Control Lumbar Flexion Rigid Posterior Frame/Panels Lateral Articulating Design To Flex The Lumbar Spine Posterior Extends From Sacrococcygeal Junction To T-9 Vertebra Lateral Strength Provided By Rigid Lateral Frame/Panels Produces Intracavitary Pressure To Reduce Load On Intervertebral Discs Includes Straps Closures May Include Padding Anterior Panel Pendulous Abdomen Design Custom Fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$775.50 / $1,077.33 / $1,077.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,578.59 / $2,045.21 / $3,791.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$970.78 / $1,018.72 / $1,018.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,030.36 / $1,030.36 / $1,030.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$752.17 / $752.17 / $1,030.36
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,437.05 / $1,437.05 / $1,437.05
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$999.38 / $1,077.33 / $1,077.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$613.63 / $981.80 / $2,036.32