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Replacement KAFO-AFO Metal Bands, Calf or Distal Thigh

Maine rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Rates data updated July 2026.

Facilitymedian $123 · 10th–90th $62$1510%20%10th90th$123Professionalmedian $72 · 10th–90th $51$1050%20%10th90th$72$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$61.66
Typical High
$75.86
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$141.25
Typical High
$158.49
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$81.28
Cigna
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$66.07
Typical High
$87.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$66.07
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$104.71
Typical High
$123.03
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$66.07
Typical High
$75.86
United
Setting
Facility
Modifier
Global
Typical Low
$32.36
Median
$50.12
Typical High
$64.57
United
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$102.33
Typical High
$104.71