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Ohio 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
$45.44 / $67.63 / $142.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.51 / $54.02 / $91.64
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.59 / $67.45 / $118.48
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.44 / $98.92 / $256.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.87 / $50.45 / $119.91
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.44 / $76.44 / $76.44
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.94 / $98.92 / $133.57
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.45 / $111.05 / $152.88
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
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.94 / $58.00 / $58.00
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.34 / $58.00 / $72.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.15 / $52.45 / $68.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $44.87 / $67.59