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Utah rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.76 / $32.76 / $32.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.76 / $42.35 / $357.76
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 / $66.72 / $71.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.21 / $74.27 / $96.55
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.08 / $99.35 / $99.35
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.57 / $71.22 / $106.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.98 / $61.98 / $61.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.74 / $50.75 / $77.67