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Delaware rates for HCPCS L1904

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $257.04 / $467.74
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 / $239.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.42 / $346.74 / $363.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $331.13 / $478.63