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Nebraska rates for HCPCS L1900

Ankle-foot orthosis (AFO), spring wire, dorsiflexion assist calf band, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $199.53 / $199.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $199.53 / $1,479.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $309.03 / $309.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $190.55 / $354.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $398.11 / $588.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $354.81 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $158.49 / $331.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $346.74 / $794.33
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $354.81 / $354.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $794.33 / $794.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $173.78 / $354.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $158.49 / $239.88