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Maine rates for HCPCS L0642

Lumbar orthosis (LO), sagittal control, with rigid anterior and posterior panels, 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, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.21 / $293.42 / $293.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$276.55 / $358.30 / $664.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.55 / $280.55 / $283.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.51 / $301.51 / $301.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.10 / $220.10 / $301.51
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.40 / $391.40 / $391.40
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.08 / $293.42 / $293.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.78 / $242.45 / $554.60