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New Jersey rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.22 / $41.22 / $41.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.22 / $48.52 / $61.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.11 / $66.72 / $121.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.71 / $48.71 / $106.02
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.62 / $111.39 / $158.61
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.24 / $121.08 / $121.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.98 / $61.98 / $61.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.09 / $60.41 / $121.08