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Nebraska 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
$430.19 / $430.19 / $430.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.19 / $430.19 / $558.61
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.94 / $505.94 / $505.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$592.88 / $652.16 / $658.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.48 / $742.04 / $742.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$419.48 / $742.04 / $1,144.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$339.67 / $738.39 / $3,157.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.80 / $336.55 / $662.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$739.88 / $742.04 / $934.97
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$617.00 / $876.95 / $1,528.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.99 / $336.55 / $455.91