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Michigan 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
$282.67 / $282.67 / $282.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.19 / $282.67 / $282.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$749.15 / $1,492.60 / $2,718.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$470.21 / $494.96 / $668.20
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$256.00 / $256.00 / $321.72
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.97 / $395.97 / $395.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.11 / $246.11 / $246.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.10 / $246.11 / $573.75
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$282.67 / $357.68 / $357.68
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.85 / $357.68 / $519.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.32 / $366.27 / $421.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.74 / $228.31 / $354.25