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Pennsylvania rates for HCPCS L1930

Ankle-foot orthosis (AFO), plastic or other material, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.50 / $1,332.12 / $1,332.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.73 / $134.38 / $200.09
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.93 / $266.51 / $266.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.81 / $175.81 / $266.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.34 / $128.34 / $233.36
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.19 / $266.51 / $506.37
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.51 / $82.51 / $1,231.76
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.96 / $186.56 / $226.54
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.50 / $1,332.12 / $1,332.12
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.41 / $131.00 / $202.93
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.10 / $115.70 / $525.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.81 / $175.81 / $266.51
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.34 / $128.34 / $351.75
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.30 / $253.66 / $253.66
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.30 / $253.66 / $288.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.80 / $133.18 / $240.34