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New Mexico 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
$334.22 / $334.22 / $334.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$334.22 / $513.27 / $1,909.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.35 / $544.47 / $648.74
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 / $419.48 / $419.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.73 / $998.42 / $1,497.63
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.06 / $195.06 / $512.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.22 / $419.48 / $775.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.35 / $302.14 / $455.14