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Ohio rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.70 / $95.50 / $100.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $53.70 / $91.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $109.65 / $223.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $61.66 / $134.90
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.70 / $79.43 / $128.82
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $95.50 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $66.07 / $66.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $66.07
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $66.07 / $144.54
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $66.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $61.66 / $89.13
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $117.49 / $213.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.66 / $54.95 / $117.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $51.29 / $75.86