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Michigan rates for HCPCS L3201

Orthopedic shoe, Oxford with supinator or pronator, infant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.63 / $19.63 / $19.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.68 / $19.63 / $25.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.70 / $156.81 / $285.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.40 / $52.00 / $70.20
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.00 / $45.00 / $48.59
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.30 / $55.30 / $55.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.06 / $30.06 / $30.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.13 / $30.06 / $43.34
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.63 / $34.70 / $34.70
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.68 / $34.70 / $40.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.56 / $17.13 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.04 / $22.95 / $38.88