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Indiana rates for HCPCS L1900

Ankle-foot orthosis (AFO), spring wire, dorsiflexion assist calf band, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $169.82 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $177.83 / $239.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $346.74 / $436.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $186.21 / $331.13
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $426.58 / $512.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $190.55 / $346.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $138.04 / $302.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $213.80 / $275.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $165.96 / $234.42