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Missouri 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
$353.14 / $353.14 / $470.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.47 / $365.99 / $558.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$674.58 / $708.31 / $3,113.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.99 / $396.47 / $545.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.48 / $419.48 / $419.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.22 / $306.22 / $491.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$337.66 / $546.02 / $3,157.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.33 / $336.55 / $819.97
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$627.04 / $627.04 / $627.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.33 / $336.55 / $598.92