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Tennessee 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
$153.30 / $153.30 / $167.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.51 / $161.82 / $286.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.01 / $306.68 / $306.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.46 / $189.91 / $189.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.63 / $138.63 / $189.91
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$532.41 / $1,586.19 / $1,632.96
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,931.89 / $1,931.89 / $2,279.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.33 / $162.88 / $224.63