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Idaho 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
$38.00 / $143.84 / $143.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.60 / $74.41 / $107.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.00 / $58.00 / $64.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.34 / $58.00 / $61.83
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.97 / $77.68 / $110.27
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.24 / $104.76 / $110.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $81.37 / $96.92
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.56 / $107.69 / $161.54
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.19 / $77.19 / $115.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $44.87 / $73.68