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Indiana rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.40 / $50.40 / $101.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.60 / $52.34 / $56.81
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.45 / $91.15 / $101.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.67 / $61.97 / $85.51
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.94 / $112.02 / $152.76
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.56 / $112.02 / $137.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.72 / $66.72 / $101.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.71 / $66.72 / $104.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.98 / $61.98 / $61.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.84 / $50.75 / $75.02