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Pennsylvania rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $162.18 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $54.95 / $95.50
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $102.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $66.07 / $123.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $66.07
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $162.18 / $234.42
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $104.71 / $104.71
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $72.44 / $104.71
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $41.69 / $162.18
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $57.54 / $107.15
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $194.98 / $194.98
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $165.96 / $239.88
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.98 / $48.98 / $97.72
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $97.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $138.04 / $165.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $51.29 / $93.33