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Kansas 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
$441.01 / $441.01 / $441.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.63 / $288.94 / $441.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$351.61 / $370.12 / $393.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.06 / $408.06 / $408.06
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 / $331.03 / $787.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.63 / $429.20 / $2,763.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.20 / $265.69 / $680.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.20 / $265.69 / $355.83