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Illinois rates for HCPCS L1900

Ankle Foot Orthosis Spring Wire Dorsiflexion Assist Calf Band Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.68 / $176.68 / $176.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.08 / $176.68 / $275.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$410.22 / $694.02 / $2,957.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.28 / $261.26 / $261.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.91 / $189.91 / $348.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.63 / $189.91 / $398.63
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.22 / $343.76 / $418.43
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
$446.89 / $446.89 / $446.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.06 / $277.23 / $291.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.68 / $171.49 / $303.67