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California rates for HCPCS L1900

Ankle Foot Orthosis Spring Wire Dorsiflexion Assist Calf Band Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$182.54 / $182.54 / $991.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.34 / $182.54 / $991.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.62 / $503.81 / $1,091.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.70 / $185.10 / $319.70
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.20 / $407.01 / $726.80
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $456.13 / $1,062.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.80 / $189.91 / $189.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.63 / $138.63 / $202.45
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.35 / $158.82 / $378.16
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.27 / $240.65 / $532.86
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$697.83 / $1,632.96 / $1,632.96
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,931.89 / $1,931.89 / $2,279.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800.07 / $800.07 / $800.07
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.89 / $296.83 / $360.97
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.63 / $189.91 / $318.95
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$648.85 / $648.85 / $648.85
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.35 / $225.00 / $275.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.28 / $168.36 / $459.95