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New Jersey 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
Facility
Modifier
Low / Median / High Price
$171.39 / $171.39 / $171.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.10 / $189.17 / $277.08
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.20 / $362.20 / $362.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$272.81 / $301.51 / $301.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.10 / $220.10 / $353.25
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.99 / $300.08 / $441.62
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.81 / $401.95 / $401.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.50 / $241.17 / $397.17