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Virginia 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
$51.93 / $51.93 / $80.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.86 / $51.93 / $73.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.02 / $105.02 / $111.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.74 / $54.74 / $70.30
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.00 / $56.00 / $71.79
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.51 / $94.52 / $126.02
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.97 / $64.59 / $117.84
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.00 / $126.00 / $174.93
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.59 / $79.26 / $131.28
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.59 / $79.26 / $131.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $52.40 / $78.93