go back

South 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
$52.75 / $52.75 / $52.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.62 / $52.75 / $93.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.00 / $78.16 / $112.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.47 / $66.72 / $73.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.71 / $64.09 / $66.72
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.43 / $77.00 / $167.39
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $64.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.02 / $72.02 / $72.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.98 / $61.98 / $61.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.45 / $50.81 / $68.43