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Rhode Island rates for HCPCS L1902

Ankle orthosis (AO), ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $83.18 / $204.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $204.17 / $239.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $67.61 / $109.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $57.54 / $60.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $42.66 / $57.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $54.95 / $123.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $54.95 / $87.10