go back

Idaho rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $70.79 / $117.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $131.83 / $218.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $151.36 / $151.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $66.07 / $77.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $66.07
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.11 / $104.71 / $138.04
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $131.83 / $138.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $97.72 / $120.23
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $131.83 / $131.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $97.72 / $151.36
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $138.04 / $138.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $58.88 / $66.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $51.29 / $70.79