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Rhode Island rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $57.54 / $181.97
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $234.42 / $275.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $66.07 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $69.18 / $69.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $66.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $63.10 / $138.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $63.10 / $97.72