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Replacement KAFO-AFO Metal Bands, Calf or Distal Thigh

Wisconsin rates for HCPCS L4090

Replace metal bands KAFO-AFO, calf or distal thigh

Rates data updated July 2026.

Facilitymedian $105 · 10th–90th $79$2090%50%10th90th$105Professionalmedian $98 · 10th–90th $51$1740%10%20%10th90th$98$0.1$0.5$2.0$10.0$50.0$200.0

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
$51.29
Median
$51.29
Typical High
$51.29
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$97.72
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$104.71
Typical High
$169.82
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$97.72
Typical High
$117.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$239.88
Typical High
$524.81
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$151.36
Typical High
$194.98
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$83.18
Typical High
$128.82
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$154.88
Typical High
$194.98
Medica
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$102.33
Typical High
$537.03
Medica
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$60.26
Typical High
$123.03
Molina
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$58.88
Typical High
$85.11
Network Health
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$165.96
Network Health
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$117.49
Typical High
$204.17
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$83.18
Typical High
$128.82
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$102.33
Typical High
$123.03
Quartz
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$158.49
Typical High
$302.00
Quartz
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$208.93
Typical High
$549.54
Quartz
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$154.88
Typical High
$691.83
United
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$58.88
Typical High
$104.71
United
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$51.29
Typical High
$97.72