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New Jersey rates for HCPCS L4000

Replace girdle for spinal orthosis (cervical-thoracic-lumbar-sacral orthosis (CTLSO) or spinal orthosis SO)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.01 / $489.01 / $489.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.01 / $697.94 / $862.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$885.33 / $897.58 / $1,436.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.23 / $655.23 / $1,845.75
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,312.31 / $1,321.53 / $1,881.75
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,402.78 / $1,436.45 / $1,436.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.27 / $957.27 / $957.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$644.97 / $716.63 / $1,436.45