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Louisiana 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
$64.81 / $68.79 / $92.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.58 / $64.81 / $74.78
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.41 / $108.00 / $215.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.37 / $178.29 / $250.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.18 / $85.14 / $85.14
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.52 / $79.52 / $79.52
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 / $56.94 / $58.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $52.26 / $71.95