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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
$48.86 / $118.68 / $118.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.72 / $66.72 / $77.76
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 / $95.46 / $135.54
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.99 / $128.76 / $135.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $100.03 / $119.12
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.68 / $132.36 / $198.54
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.88 / $94.88 / $142.32
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 / $50.75 / $80.50