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Nebraska rates for HCPCS L1902

Ankle orthosis (AO), ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.53 / $60.53 / $60.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $75.00 / $231.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.18 / $89.93 / $142.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.42 / $91.76 / $92.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.94 / $58.00 / $104.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.00 / $104.40 / $161.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.55 / $103.89 / $472.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.14 / $47.35 / $95.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.10 / $104.40 / $136.62
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.54 / $125.13 / $215.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.33 / $47.35 / $67.52