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Illinois rates for HCPCS L1920

Ankle Foot Orthosis Single Upright With Static Or Adjustable Stop (Phelps Or Perlstein Type) Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.40 / $254.40 / $254.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.09 / $254.40 / $355.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$591.48 / $1,000.68 / $4,258.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.01 / $376.17 / $376.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.11 / $246.11 / $433.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.66 / $246.10 / $573.75
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.40 / $461.16 / $580.49
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
$643.45 / $643.45 / $643.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.41 / $399.17 / $419.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.56 / $244.73 / $423.90