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Maine 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
Professional
Modifier
Low / Median / High Price
$54.02 / $56.20 / $62.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.13 / $119.37 / $221.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.74 / $57.39 / $57.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.00 / $58.00 / $76.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.34 / $47.49 / $58.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.88 / $83.88 / $83.88
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.96 / $62.12 / $75.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.46 / $51.68 / $118.86