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Virginia rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.00 / $50.74 / $50.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.00 / $50.74 / $59.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.62 / $102.62 / $108.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.97 / $61.97 / $79.95
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $55.00 / $70.15
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.83 / $92.36 / $123.14
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.76 / $63.11 / $116.81
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $128.28 / $170.92
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.19 / $77.67 / $128.49
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.19 / $77.67 / $128.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.98 / $61.98 / $61.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.09 / $51.19 / $78.20