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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
$51.71 / $61.10 / $70.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.33 / $226.03 / $267.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.64 / $66.64 / $107.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.72 / $66.72 / $68.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.71 / $66.72 / $66.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.09 / $62.57 / $98.41