go back

Mississippi 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
$296.88 / $296.88 / $473.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.10 / $338.63 / $473.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$410.53 / $410.53 / $410.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.53 / $410.53 / $410.53
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 / $331.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.20 / $251.50 / $418.05