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Nebraska rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.19 / $83.19 / $83.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.19 / $83.19 / $108.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.66 / $126.13 / $127.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.72 / $143.51 / $143.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.72 / $143.51 / $221.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.36 / $141.41 / $538.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.54 / $65.08 / $108.47
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.08 / $143.51 / $180.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.78 / $167.63 / $294.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.98 / $61.98 / $61.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.39 / $61.83 / $102.10