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Missouri rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.29 / $68.29 / $90.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.70 / $70.78 / $108.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.46 / $136.97 / $602.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.58 / $61.97 / $105.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.72 / $66.72 / $66.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.71 / $48.71 / $71.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.72 / $101.85 / $538.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.39 / $65.08 / $158.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.98 / $61.98 / $61.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.30 / $62.36 / $96.74