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Replacement KAFO-AFO Metal Bands, Calf or Distal Thigh

South Dakota rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Rates data updated July 2026.

Facilitymedian $102 · 10th–90th $69$1480%10%10th90th$102Professionalmedian $98 · 10th–90th $69$1480%10%20%10th90th$98$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
Facility
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$74.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$70.79
Typical High
$117.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$66.07
Typical High
$147.91
Cigna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$120.23
Typical High
$147.91
Medica
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$117.49
Typical High
$190.55
Medica
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$72.44
Typical High
$676.08
Midlands
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$144.54
Typical High
$144.54
Midlands
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$147.91
Midlands
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$181.97
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$102.33
Typical High
$134.90
United
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$58.88
Typical High
$85.11
United
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$77.62
Typical High
$120.23
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89