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Maryland rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $53.70 / $93.33
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $54.95 / $72.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $66.07 / $66.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $66.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $104.71 / $158.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $50.12 / $75.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $51.29 / $81.28
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $87.10