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Missouri 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
$165.68 / $165.68 / $220.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.68 / $171.71 / $262.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.49 / $332.31 / $1,460.92
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.92 / $185.10 / $256.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.91 / $189.91 / $189.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.63 / $138.63 / $202.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.68 / $256.17 / $1,586.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.62 / $157.88 / $384.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.63 / $157.88 / $325.22