go back

Alaska rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.90 / $102.90 / $102.90
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 / $66.72 / $71.13
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.76 / $32.76 / $32.76
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.11 / $128.76 / $180.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.76 / $32.76 / $66.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.71 / $71.13 / $129.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.06 / $114.86 / $149.82