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Wisconsin rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Facilitymedian $105 · 10th–90th $83$1910%50%10th90th$105Professionalmedian $81 · 10th–90th $49$1550%20%10th90th$81$0.1$0.5$2.0$10.0$50.0$200.0

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
$51.29 / $51.29 / $51.29
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $52.48 / $91.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $169.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $114.82
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $239.88 / $512.86
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $147.91 / $194.98
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $83.18 / $128.82
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $154.88 / $194.98
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $102.33 / $537.03
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $60.26 / $123.03
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $58.88 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $165.96
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $117.49 / $204.17
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $158.49 / $316.23
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $208.93 / $588.84
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $97.72 / $676.08
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $58.88 / $104.71
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $51.29 / $87.10