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Iowa rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.76 / $70.76 / $74.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.23 / $61.10 / $95.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.72 / $66.72 / $143.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.72 / $118.13 / $147.66
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.84 / $132.88 / $143.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.95 / $150.18 / $538.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.75 / $65.08 / $171.11
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.08 / $143.51 / $171.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.00 / $154.56 / $274.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.98 / $61.98 / $61.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.30 / $65.08 / $132.38
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.94 / $123.94 / $123.94
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.91 / $123.94 / $123.94