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Michigan rates for HCPCS L2387

Addition to lower extremity, polycentric knee joint, for custom fabricated knee-ankle-foot orthosis (KAFO), each joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.35 / $131.35 / $131.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.98 / $131.35 / $131.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$336.41 / $693.59 / $1,263.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.50 / $230.00 / $310.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.11 / $141.32 / $149.50
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.00 / $184.00 / $184.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.51 / $116.51 / $116.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.61 / $116.51 / $266.63
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.35 / $166.22 / $166.22
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.54 / $166.22 / $241.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.66 / $170.20 / $195.73
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.54 / $92.18 / $118.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.83 / $108.01 / $153.69