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Maine rates for HCPCS L0641

Lumbar Orthosis 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