go back

Replacement KAFO-AFO Metal Bands, Calf or Distal Thigh

Utah rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Rates data updated July 2026.

Facilitymedian $50 · 10th–90th $33$1020%20%40%10th90th$50Professionalmedian $62 · 10th–90th $33$5370%10%10th90th$62$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
Facility
Modifier
Global
Typical Low
$33.11
Median
$33.11
Typical High
$33.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$57.54
Typical High
$537.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$66.07
Typical High
$66.07
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$66.07
Molina
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$74.13
Typical High
$95.50
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$102.33
Typical High
$102.33
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$72.44
Typical High
$151.36
Select Health
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$104.71
Typical High
$104.71
Select Health
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$104.71
Typical High
$138.04
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$104.71
Typical High
$154.88
United
Setting
Facility
Modifier
Global
Typical Low
$42.66
Median
$51.29
Typical High
$66.07
United
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$51.29
Typical High
$77.62