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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
$141.25 / $213.80 / $512.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $371.54 / $426.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $281.84 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $302.00 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $218.78 / $302.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $323.59
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $288.40 / $512.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $218.78 / $218.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $269.15 / $426.58