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Michigan rates for HCPCS L0112

Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$963.05 / $963.05 / $963.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$799.97 / $963.05 / $963.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,552.37 / $5,085.30 / $9,262.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,602.01 / $1,686.33 / $2,276.55
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,069.85 / $1,096.10 / $1,102.06
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,349.06 / $1,349.06 / $1,349.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$941.33 / $941.33 / $941.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$852.47 / $941.33 / $1,954.88
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$963.05 / $1,218.63 / $1,218.63
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$963.05 / $1,218.63 / $1,770.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $1,247.88 / $1,435.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.46 / $791.91 / $1,191.96