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Maryland rates for HCPCS L1920

Ankle-foot orthosis (AFO), single upright with static or adjustable stop (Phelps or Perlstein type), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $213.80 / $346.74
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $208.93 / $275.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $245.47 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $177.83 / $245.47
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $398.11 / $602.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $190.55 / $295.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $194.98 / $316.23
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $331.13