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Minnesota 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
$61.66 / $61.66 / $107.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $72.44 / $173.78
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $131.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $89.13 / $89.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $331.13 / $812.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $117.49 / $131.83
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $331.13 / $630.96
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $104.71 / $141.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.65 / $89.13 / $239.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $58.88 / $104.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $44.67 / $123.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $46.77 / $109.65