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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
$239.00 / $239.00 / $261.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.58 / $252.28 / $447.35
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$451.55 / $451.55 / $531.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.52 / $478.12 / $478.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$268.43 / $313.79 / $313.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.07 / $229.07 / $313.79
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$898.34 / $2,738.27 / $3,180.46
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,766.55 / $3,856.95 / $4,491.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.69 / $259.50 / $370.22