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Illinois rates for HCPCS L1907

Afo Orthosis Supramalleolar With Straps With Orwithout Interface/Pads Custom Fabricated (Revised01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$348.47 / $348.47 / $2,820.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.33 / $348.47 / $542.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$810.90 / $1,371.90 / $5,833.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.99 / $515.27 / $515.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.48 / $419.48 / $742.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.22 / $419.48 / $786.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$576.29 / $745.79 / $955.01
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$881.39 / $881.39 / $881.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.73 / $546.77 / $574.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.79 / $338.24 / $598.92