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Texas rates for HCPCS L4110

Replace leather cuff KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.21 / $48.14 / $49.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.36 / $49.06 / $83.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.31 / $50.31 / $62.95
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.72 / $105.72 / $105.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.81 / $61.81 / $61.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.12 / $45.12 / $61.81
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$214.41 / $510.12 / $605.05
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$677.70 / $693.95 / $944.55
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.77 / $73.14 / $105.72
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.77 / $95.15 / $127.38
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.77 / $70.64 / $105.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.12 / $45.12 / $65.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.72 / $58.76 / $68.38
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.20 / $57.23 / $105.72