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Nebraska rates for HCPCS L1990

Ankle Foot Orthosis 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
$369.65 / $369.65 / $369.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.65 / $369.65 / $480.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.70 / $492.70 / $492.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$509.44 / $560.39 / $566.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.79 / $637.62 / $637.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.79 / $637.62 / $983.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.42 / $634.48 / $2,738.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.03 / $289.18 / $481.97
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$635.75 / $637.62 / $803.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$550.00 / $753.55 / $1,313.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.56 / $289.18 / $377.39