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New Jersey rates for HCPCS L4050

Replace Molded Calf Lacer, For Custom Fabricated Orthotic Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.12 / $211.12 / $211.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.41 / $242.69 / $279.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.63 / $290.63 / $620.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.16 / $212.16 / $543.01
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.54 / $570.52 / $812.37
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$605.60 / $620.13 / $620.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.22 / $444.22 / $444.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.69 / $309.38 / $620.13