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Tennessee rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.95 / $47.95 / $52.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.06 / $51.37 / $89.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.51 / $95.93 / $95.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.38 / $66.72 / $66.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.71 / $48.71 / $66.72
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.62 / $538.29 / $589.04
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.92 / $670.92 / $908.10
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 / $50.96 / $73.36