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Replacement KAFO-AFO Metal Bands, Calf or Distal Thigh

California rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Rates data updated July 2026.

Facilitymedian $59 · 10th–90th $47$2690%20%10th90th$59Professionalmedian $62 · 10th–90th $48$5370%20%40%10th90th$62$0.1$0.5$2.0$10.0$50.0$200.0$1.0K

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
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$537.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$61.66
Typical High
$537.03
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$58.88
Typical High
$251.19
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$61.66
Typical High
$141.25
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$194.98
Typical High
$302.00
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$117.49
Typical High
$323.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$66.07
Typical High
$66.07
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$66.07
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$53.70
Typical High
$151.36
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$114.82
Typical High
$204.17
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$602.56
Typical High
$602.56
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$912.01
Typical High
$912.01
Molina
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$128.82
Typical High
$128.82
Optum
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$70.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$107.15
Typical High
$154.88
Providence
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$128.82
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$234.42
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$57.54
Typical High
$114.82
United
Setting
Facility
Modifier
Global
Typical Low
$8.32
Median
$50.12
Typical High
$138.04
United
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$60.26
Typical High
$128.82