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Michigan rates for HCPCS L1000

Cervical-thoracic-lumbar-sacral orthosis (CTLSO) (Milwaukee), inclusive of furnishing initial orthotic, including model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,395.28 / $1,395.28 / $1,395.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,203.22 / $1,395.28 / $1,402.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,697.91 / $7,367.65 / $13,418.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,321.02 / $2,443.17 / $3,298.29
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,486.70 / $1,501.94 / $1,588.07
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,954.54 / $1,954.54 / $1,954.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,499.97 / $1,499.97 / $1,499.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,499.97 / $1,499.97 / $2,832.38
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,395.28 / $1,765.56 / $1,765.56
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,382.40 / $1,765.56 / $2,565.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,482.51 / $1,807.95 / $2,079.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$893.45 / $1,147.33 / $1,748.65