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Tennessee 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
$306.67 / $306.67 / $335.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.12 / $316.31 / $573.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.13 / $613.48 / $613.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$353.71 / $419.48 / $419.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.22 / $306.22 / $419.48
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,065.06 / $3,157.08 / $3,157.08
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,413.19 / $3,413.19 / $4,962.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.71 / $327.33 / $455.14