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Replacement KAFO-AFO Metal Bands, Calf or Distal Thigh

Washington rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Rates data updated July 2026.

Facilitymedian $132 · 10th–90th $91$2630%20%10th90th$132Professionalmedian $112 · 10th–90th $51$2090%10%20%10th90th$112$1.0$5.0$20.0$100.0$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
$91.20
Median
$91.20
Typical High
$218.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$91.20
Typical High
$537.03
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$131.83
Typical High
$134.90
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$151.36
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
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$151.36
Typical High
$389.05
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$147.91
Typical High
$234.42
Molina
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$104.71
Typical High
$114.82
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$131.83
Typical High
$134.90
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$117.49
Typical High
$134.90
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$199.53
Typical High
$269.15
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$131.83
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$134.90
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$117.49
Typical High
$151.36
United
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$138.04
Typical High
$165.96
United
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$58.88
Typical High
$100.00
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$61.66
Typical High
$117.49