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Nebraska rates for HCPCS L1990

Ankle-foot orthosis (AFO), double upright free plantar dorsiflexion, solid stirrup, calf band/cuff (double bar 'BK' orthosis), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $371.54 / $371.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $371.54 / $2,884.03
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $489.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $562.34 / $562.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $316.23 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $645.65 / $977.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $630.96 / $2,754.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $288.40 / $575.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $630.96 / $1,445.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $645.65 / $645.65
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,445.44 / $1,445.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $295.12 / $575.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $288.40 / $457.09