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Rhode Island 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
$29.83 / $54.02 / $61.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.47 / $197.81 / $234.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.51 / $67.66 / $93.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.94 / $58.00 / $59.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.34 / $56.94 / $58.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.03 / $52.35 / $86.14