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North Dakota 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
$385.43 / $385.43 / $385.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.18 / $377.87 / $385.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$495.33 / $585.65 / $600.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.38 / $636.67 / $800.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.86 / $385.43 / $2,763.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.05 / $264.29 / $440.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.94 / $308.33 / $611.82