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New Hampshire rates for HCPCS L4090

Replace Metal Bands Kafo-Afo, Calf Or Distal Thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.64 / $66.64 / $79.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.23 / $51.71 / $66.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.36 / $118.36 / $140.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.97 / $61.97 / $64.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.72 / $66.72 / $66.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.71 / $48.71 / $71.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.83 / $95.83 / $295.77
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.98 / $61.98 / $61.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.36 / $59.05 / $64.98
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.64 / $97.50 / $124.10