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Michigan rates for HCPCS L1830

Knee orthosis (KO), immobilizer, canvas longitudinal, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.41 / $125.13 / $192.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.49 / $47.90 / $65.09
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.78 / $65.78 / $70.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.27 / $207.74 / $378.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.45 / $68.89 / $93.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.78 / $68.89 / $102.32
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.11 / $89.56 / $105.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.14 / $67.14 / $76.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.14 / $67.14 / $83.34
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.40 / $125.13 / $192.35
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.40 / $65.09 / $86.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.22 / $64.91 / $74.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.34 / $49.17 / $75.33