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Minnesota 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
$62.49 / $62.49 / $62.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.49 / $54.02 / $97.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.04 / $89.93 / $125.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.94 / $85.43 / $89.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.00 / $274.58 / $642.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.25 / $110.51 / $132.40
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.61 / $266.02 / $606.35
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.25 / $104.25 / $107.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.84 / $89.93 / $472.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.24 / $67.59 / $105.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $44.87 / $104.74