go back

Arizona 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
$55.65 / $55.65 / $77.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.22 / $54.02 / $220.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.29 / $79.34 / $103.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.06 / $97.74 / $176.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.27 / $90.18 / $116.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.00 / $58.00 / $58.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.34 / $42.34 / $104.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.97 / $71.81 / $472.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.51 / $44.87 / $68.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.51 / $44.87 / $67.59