HCPCS L4090
Replace metal bands kafo-afo, calf or distal thigh
Current codeBelow Knee Orthotic23 hospitals with prices
What Washington hospitals publish for this code
Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.
| Hospital | Commercial insurance rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $119 – $924 | — | — |
| Deaconess Medical Center | $165 – $575 | — | — |
| Harborview Medical Center | $221 – $277 | $169 | $242 |
| Kadlec Regional Medical Center | $208 – $388 | — | — |
| Mary Bridge Children's Hospital | $119 – $1,015 | — | — |
| MultiCare Auburn Medical Center | $116 – $597 | — | — |
| MultiCare Covington Medical Center | $116 – $597 | — | — |
| MultiCare Good Samaritan Hospital | $134 – $597 | — | — |
| MultiCare Valley Hospital | $132 – $574 | — | — |
| Overlake Hospital Medical Center & Clinics | $127 – $380 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $214 – $459 | — | — |
| Providence Centralia Hospital | $234 – $517 | — | — |
| Providence Regional Medical Center Everett | $166 – $321 | — | — |
| Providence St Peter Hospital | $118 – $451 | — | — |
| Swedish Edmonds Hospital | $207 – $507 | — | — |
| Swedish Issaquah | $207 – $307 | — | — |
| Swedish Medical Center | $207 – $494 | — | — |
| Swedish Medical Center / Cherry Hill | $207 – $494 | — | — |
| Tacoma General Allenmore Hospital | $116 – $597 | — | — |
| University of Washington Medical Ctr | $221 – $434 | $214 | $305 |
| Virginia Mason Medical Center | $132 – $481 | — | — |
| Wellfound Behavioral Health Hospital | $349 | — | — |
| Yakima Valley Memorial | $119 – $359 | — | — |
Medicare (traditional) reference
Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.
- Equipment fee, Washington
- $138 (fee)