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Iowa 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
$62.49 / $62.49 / $65.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.34 / $54.02 / $83.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.94 / $58.00 / $104.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.00 / $104.25 / $130.31
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.70 / $94.80 / $108.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.62 / $109.32 / $472.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.47 / $51.86 / $129.68
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.10 / $104.40 / $136.62
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.51 / $123.38 / $199.52
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.73 / $98.24 / $169.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.47 / $47.35 / $111.65
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.01 / $93.01 / $93.01
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.48 / $93.01 / $93.01