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Colorado 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
$296.67 / $296.67 / $296.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.43 / $296.67 / $398.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$529.76 / $595.24 / $1,080.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.16 / $322.16 / $331.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.03 / $331.03 / $331.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.65 / $241.65 / $569.87
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.63 / $296.67 / $666.47
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.63 / $170.63 / $170.63
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.72 / $662.20 / $1,048.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.99 / $264.29 / $398.13