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Washington, DC 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
$258.49 / $258.49 / $258.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.49 / $258.49 / $258.49
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.00 / $339.00 / $431.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.65 / $241.65 / $241.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.51 / $410.51 / $1,253.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.05 / $315.08 / $473.40