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Illinois rates for HCPCS L4090

Replace Metal Bands Kafo-Afo, Calf Or Distal Thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.34 / $52.34 / $52.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.35 / $53.31 / $81.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.43 / $207.13 / $876.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.72 / $66.72 / $143.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.71 / $66.72 / $118.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $140.86 / $174.34
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.38 / $132.38 / $132.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.72 / $76.75 / $80.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.98 / $61.98 / $61.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.74 / $50.80 / $87.39