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Texas rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.48 / $58.60 / $59.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.34 / $59.73 / $93.33
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.71 / $128.71 / $128.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.72 / $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
$538.29 / $589.04 / $589.04
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.92 / $670.92 / $908.10
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.76 / $87.03 / $128.71
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.76 / $109.40 / $135.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.76 / $86.01 / $128.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.71 / $48.71 / $71.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.98 / $61.98 / $61.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.30 / $61.16 / $72.81
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.95 / $61.97 / $128.71