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Wyoming 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
$296.67 / $296.67 / $463.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$517.35 / $517.35 / $517.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$517.35 / $517.35 / $517.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.03 / $331.03 / $585.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.65 / $241.65 / $331.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.88 / $264.29 / $293.42