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Alabama rates for HCPCS L1904

Ankle orthosis (AO), ankle gauntlet or similar, with or without joints, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.80 / $477.80 / $477.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.18 / $477.80 / $477.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.78 / $370.78 / $370.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.03 / $331.03 / $543.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.65 / $331.03 / $476.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.20 / $264.29 / $404.45