go back

Louisiana 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
$286.32 / $303.94 / $409.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.54 / $303.94 / $338.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$461.10 / $787.73 / $1,107.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.45 / $376.13 / $376.13
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $331.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.20 / $251.50 / $404.45