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Maryland 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
$52.21 / $52.21 / $106.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.98 / $54.02 / $175.00
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.00 / $56.00 / $71.79
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.51 / $105.02 / $151.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.19 / $52.40 / $83.52
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.50 / $53.88 / $73.51