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Indiana 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
$170.14 / $170.14 / $343.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.60 / $170.14 / $184.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$271.57 / $307.67 / $343.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.70 / $185.10 / $255.43
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.82 / $378.14 / $511.13
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.20 / $378.14 / $464.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.91 / $189.91 / $343.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.63 / $189.91 / $348.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.08 / $169.96 / $232.51