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Idaho 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
$263.83 / $559.50 / $559.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.79 / $313.79 / $419.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.07 / $313.79 / $334.52
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.74 / $450.09 / $638.97
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.07 / $607.02 / $638.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $471.55 / $561.59
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$559.50 / $623.99 / $935.99
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.28 / $447.28 / $670.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.64 / $250.53 / $397.34