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Indiana 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
$44.51 / $292.25 / $292.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.50 / $48.31 / $83.30
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.00 / $67.45 / $94.43
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.04 / $80.48 / $89.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.87 / $54.74 / $75.54
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.66 / $103.42 / $134.90
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.93 / $107.92 / $129.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.94 / $58.00 / $89.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.34 / $58.00 / $92.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $44.87 / $65.68