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Illinois rates for HCPCS L1900

Ankle-foot orthosis (AFO), spring wire, dorsiflexion assist calf band, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $346.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $177.83 / $309.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $660.69 / $2,344.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $263.03 / $263.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $190.55 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $138.04 / $346.74
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $346.74 / $436.52
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $194.98 / $275.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $275.42 / $501.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $169.82 / $257.04