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Oregon 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
$41.00 / $60.00 / $236.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.00 / $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
$77.19 / $190.33 / $248.25
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.43 / $90.63 / $110.27
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.99 / $103.65 / $115.78
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.54 / $99.24 / $121.30
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.93 / $110.27 / $132.32
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.24 / $94.01 / $115.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.34 / $96.56 / $124.38
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.87 / $183.38 / $386.88
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.83 / $121.30 / $121.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.23 / $44.87 / $85.60