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Arkansas rates for HCPCS L1902

Ankle orthosis (AO), ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.92 / $66.07 / $275.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $61.66 / $123.03
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $75.86 / $97.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218,776.16 / $524,807.46 / $954,992.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $104.71 / $138.04
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $104.71 / $128.82
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $57.54 / $97.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $42.66 / $57.54
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $109.65 / $112.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.65 / $104.71 / $123.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $50.12 / $69.18