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Illinois rates for HCPCS L1990

Ankle Foot Orthosis Double Upright Free Plantar Dorsiflexion Solid Stirrup Calf Band/Cuff (Double Bar Bk Orthosis) Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$289.39 / $289.39 / $289.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.65 / $289.39 / $450.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.57 / $1,137.86 / $4,844.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.66 / $427.91 / $427.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.79 / $313.79 / $637.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.07 / $313.79 / $652.88
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.58 / $619.34 / $762.35
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
$731.95 / $731.95 / $731.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.85 / $454.08 / $476.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.56 / $280.89 / $493.21