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California rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.10 / $61.10 / $357.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.71 / $61.10 / $357.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.40 / $179.00 / $393.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.67 / $61.97 / $94.71
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.60 / $146.78 / $262.10
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.02 / $164.53 / $383.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.99 / $66.72 / $66.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.71 / $48.71 / $71.13
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.60 / $53.52 / $136.41
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.41 / $86.81 / $192.22
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.74 / $589.04 / $589.04
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.92 / $670.92 / $908.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.85 / $263.85 / $263.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.76 / $107.69 / $128.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.71 / $66.72 / $122.48
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.03 / $234.03 / $234.03
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.60 / $75.81 / $99.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.98 / $61.98 / $61.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.93 / $50.84 / $124.01