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Arizona rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.60 / $52.75 / $93.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.56 / $117.62 / $212.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.39 / $108.52 / $147.86
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 / $118.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.76 / $86.40 / $538.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.83 / $50.75 / $76.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.98 / $61.98 / $61.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.88 / $50.75 / $76.45