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Michigan rates for HCPCS L1690

Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction and internal rotation control, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,330.58 / $1,330.58 / $1,330.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,105.26 / $1,330.58 / $1,330.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,526.46 / $7,026.08 / $12,796.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,213.41 / $2,329.91 / $3,145.38
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,478.14 / $1,514.44 / $1,522.65
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,863.93 / $1,863.93 / $1,863.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,300.55 / $1,300.55 / $1,300.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$949.40 / $1,937.28 / $3,376.41
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,330.58 / $1,683.70 / $1,683.70
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,301.96 / $1,683.70 / $2,446.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,413.78 / $1,724.13 / $1,982.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$865.31 / $1,094.14 / $1,667.56