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Vermont 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 / $50.55 / $58.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.81 / $83.81 / $83.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.94 / $58.00 / $76.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.34 / $56.21 / $61.83
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.94 / $58.00 / $76.13
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.34 / $56.94 / $61.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.46 / $61.36 / $119.76