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Tennessee 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
Facility
Modifier
Low / Median / High Price
$239.88 / $263.03 / $416.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $263.03 / $467.74
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $398.11 / $426.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $316.23 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $229.09 / $316.23
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $4,466.84 / $4,466.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $245.47 / $398.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $251.19 / $363.08