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Florida 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
$219.49 / $243.25 / $278.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.18 / $278.69 / $463.88
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 / $344.24
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.40 / $325.35 / $325.35
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.50 / $327.50 / $529.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.58 / $237.83 / $261.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.00 / $264.29 / $379.17
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.83 / $237.83 / $317.39