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Michigan rates for HCPCS L1845

Knee orthosis (KO), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$576.39 / $576.39 / $1,572.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$499.54 / $576.39 / $596.90
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.73 / $567.73 / $567.73
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,527.63 / $3,043.61 / $5,543.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$958.83 / $1,009.29 / $1,362.54
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.04 / $711.74 / $737.52
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$807.43 / $807.43 / $807.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$632.51 / $632.51 / $632.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$627.19 / $632.51 / $1,170.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$576.39 / $729.35 / $1,572.48
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$542.10 / $729.35 / $1,059.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.43 / $746.87 / $858.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.70 / $473.96 / $722.35