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Arizona rates for HCPCS L1990

Ankle-foot orthosis (AFO), double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'BK' orthosis), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.93 / $267.83 / $465.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.78 / $635.02 / $1,148.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.46 / $585.95 / $798.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.79 / $313.79 / $313.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.07 / $229.07 / $652.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.74 / $447.39 / $2,738.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.21 / $250.53 / $377.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.43 / $250.53 / $377.39