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Hawaii rates for HCPCS L1907

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $354.81 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $588.84 / $831.76
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $676.08 / $707.95
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $676.08 / $776.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $380.19 / $389.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $501.19 / $724.44