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Minnesota 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
$391.21 / $391.21 / $391.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.93 / $391.21 / $391.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$482.32 / $563.04 / $784.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.43 / $534.89 / $563.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.79 / $1,737.01 / $4,824.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$652.88 / $692.05 / $829.15
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,031.24 / $1,666.58 / $3,798.74
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$652.88 / $652.88 / $671.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.59 / $563.04 / $2,738.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.02 / $269.17 / $635.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.02 / $279.76 / $591.19