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Michigan rates for HCPCS L1920

Ankle-foot orthosis (AFO), single upright with static or adjustable stop (Phelps or Perlstein type), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $281.84 / $281.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $245.47 / $346.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $1,479.11 / $2,818.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $489.78 / $524.81
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $257.04 / $257.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $245.47 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $245.47 / $575.44
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $933.25 / $1,047.13
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $398.11 / $602.56
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $245.47 / $245.47
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $245.47 / $263.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $398.11 / $537.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $234.42 / $331.13