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Maine rates for HCPCS L0643

Lumbar-Sacral Orthosis Sagittal Control With Rigid Posterior Panel(S) Posterior Extends From Sacrococcygeal Junction To T-9 Vertebra Produces Intracavitary Pressure To Reduce Load On The Intervertebral Discs Includes Straps Closures May Include Padding Stays Shoulder Straps Pendulousabdomen Design Prefabricated Off-The-Shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.22 / $115.60 / $115.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.95 / $141.16 / $261.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.53 / $110.53 / $111.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.79 / $128.79 / $128.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.02 / $94.02 / $128.79
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.19 / $154.19 / $154.19
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.80 / $115.60 / $115.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.34 / $97.86 / $218.52