go back

North Carolina rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $93.33 / $161.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.51 / $93.33 / $93.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.46 / $102.56 / $194.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.76 / $79.94 / $79.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.93 / $66.72 / $66.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.71 / $66.72 / $118.13
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.76 / $93.33 / $125.37
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $72.48
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.30 / $145.30 / $223.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.98 / $61.98 / $61.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.58 / $53.17 / $77.09
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.62 / $589.04 / $589.04
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.92 / $670.92 / $908.10