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California rates for HCPCS L1907

Ankle orthosis (AO), supramalleolar with straps, with or without interface/pads, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.75 / $363.75 / $1,909.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.12 / $363.75 / $1,359.23
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$496.29 / $496.29 / $496.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$276.23 / $1,003.96 / $2,100.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.74 / $396.47 / $630.53
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $783.40 / $1,398.93
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $877.98 / $2,045.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.48 / $419.48 / $525.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.22 / $306.22 / $491.90
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.71 / $424.45 / $727.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.03 / $463.20 / $1,005.81
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,139.02 / $3,157.08 / $3,157.08
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,413.19 / $3,413.19 / $4,962.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,046.76 / $2,046.76 / $2,046.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.06 / $585.01 / $681.58
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.22 / $419.48 / $629.83
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,248.95 / $1,248.95 / $1,248.95
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.71 / $529.38 / $530.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.35 / $307.44 / $668.49