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Nevada 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
$241.22 / $241.22 / $278.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.22 / $258.49 / $282.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$706.35 / $706.35 / $706.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.23 / $322.16 / $706.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.03 / $331.03 / $520.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.65 / $331.03 / $466.84
Hometown Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.80 / $565.08 / $918.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.94 / $264.29 / $440.49