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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
$295.12 / $512.86 / $512.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $295.12 / $467.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $602.56 / $1,174.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $323.59 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $331.13 / $331.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $239.88 / $354.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $537.03 / $1,000.00
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $537.03 / $537.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $288.40 / $354.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $263.03 / $398.11