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Minnesota 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
$238.85 / $238.85 / $238.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.44 / $238.85 / $241.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.47 / $343.76 / $478.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.01 / $326.57 / $343.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.91 / $1,060.41 / $2,945.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.63 / $422.54 / $506.25
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$629.55 / $1,007.58 / $2,319.06
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.63 / $398.63 / $410.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.83 / $343.76 / $1,586.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.08 / $165.35 / $353.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.72 / $180.38 / $603.80