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New Mexico 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
$91.20 / $91.20 / $91.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $112.20 / $181.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $147.91 / $169.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $117.49 / $117.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $338.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $186.21 / $281.84
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $141.25 / $251.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $275.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $102.33 / $251.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $93.33 / $141.25