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Tennessee 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
$40.74 / $45.71 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $53.70 / $114.82
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $75.86 / $128.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $69.18 / $74.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $57.54 / $57.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $42.66 / $57.54
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $891.25 / $891.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.18 / $44.67 / $57.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $44.67 / $64.57