go back

Vermont rates for HCPCS L1904

Ankle orthosis (AO), ankle gauntlet or similar, with or without joints, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.70 / $344.70 / $397.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.03 / $331.03 / $519.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.65 / $331.03 / $352.89
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.03 / $331.03 / $519.17
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.65 / $331.03 / $352.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.99 / $530.84 / $816.60