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Vermont 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
$40.74 / $58.88 / $158.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $83.18 / $83.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $57.54 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $42.66 / $57.54
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $102.33 / $120.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.65 / $44.67 / $56.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $69.18 / $213.80