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Michigan rates for HCPCS L4350

Ankle Control Orthosis Stirrup Style Rigid Includes Any Type Interface (E.G. Pneumatic Gel)Prefabricated Off-The-Shelf (Revised 01/01/14) D 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.58 / $99.79 / $217.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.26 / $62.93 / $83.22
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.86 / $87.43 / $98.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.44 / $351.53 / $640.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.74 / $116.57 / $157.37
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.29 / $112.76 / $173.14
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.26 / $151.54 / $165.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.22 / $68.22 / $73.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.22 / $68.22 / $135.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.28 / $99.79 / $217.62
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.49 / $81.42 / $116.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.73 / $86.26 / $99.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.34 / $54.75 / $83.45