go back

Maine rates for HCPCS L0641

Lumbar orthosis (LO), sagittal control, with rigid posterior panel(s), posterior extends from L-1 to below 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, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.04 / $55.63 / $55.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.44 / $67.94 / $125.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.20 / $53.20 / $53.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $52.17 / $52.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.34 / $52.17 / $52.17
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
$52.53 / $55.63 / $55.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.48 / $47.11 / $105.15