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Washington rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Facilitymedian $132 · 10th–90th $79$2690%20%10th90th$132Professionalmedian $91 · 10th–90th $49$1700%10%10th90th$91$1.0$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $218.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $61.66 / $117.49
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $131.83 / $131.83
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $151.36
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $66.07 / $66.07
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $48.98 / $66.07
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $151.36 / $380.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $147.91 / $234.42
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $104.71 / $114.82
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $131.83 / $134.90
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $117.49 / $134.90
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $199.53 / $269.15
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $131.83
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $131.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $117.49 / $151.36
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $138.04 / $165.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $54.95 / $97.72
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $97.72 / $208.93