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Connecticut rates for HCPCS L1902

Ankle Orthosis Ankle Gauntlet Or Similiar With Or Without Joints Prefabricated Off-The-Shelf (Revised 01/01/2016)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.35 / $50.35 / $50.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.51 / $51.22 / $61.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.28 / $103.59 / $118.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.74 / $54.74 / $57.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.94 / $58.00 / $58.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.34 / $42.34 / $58.00
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.33 / $67.33 / $67.33
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.33 / $72.51 / $103.59
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.10 / $44.10 / $50.84
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.84 / $50.84 / $135.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.44 / $51.68 / $86.14