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New Jersey rates for HCPCS L0649

Lumbar-sacral orthosis (LSO), sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.56 / $119.56 / $119.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.83 / $131.97 / $193.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.32 / $211.82 / $211.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.63 / $154.63 / $246.38
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.09 / $209.35 / $308.07
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.24 / $21.24 / $280.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.90 / $168.24 / $277.07