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Virginia 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
$124.39 / $150.27 / $150.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.39 / $150.27 / $184.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$303.93 / $303.93 / $322.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.10 / $185.10 / $237.79
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.00 / $163.00 / $207.76
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 / $189.91
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.75 / $273.54 / $364.72
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.89 / $186.92 / $345.97
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.00 / $379.91 / $506.24
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.51 / $229.37 / $379.91
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.51 / $229.37 / $379.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.04 / $151.62 / $233.53