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Replacement KAFO-AFO Metal Bands, Calf or Distal Thigh

Montana rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Rates data updated July 2026.

Facilitymedian $100 · 10th–90th $68$1260%20%40%10th90th$100Professionalmedian $79 · 10th–90th $33$1950%20%10th90th$79$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$53.70
Typical High
$537.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$107.15
Typical High
$107.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$107.15
Typical High
$107.15
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$100.00
Typical High
$194.98
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$100.00
Typical High
$194.98
Providence
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$102.33
Typical High
$151.36
Providence
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$81.28
Typical High
$128.82
United
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$63.10
Typical High
$66.07
United
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$51.29
Typical High
$77.62