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Pennsylvania 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
$89.47 / $89.47 / $346.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.97 / $98.99 / $123.54
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.54 / $217.41 / $217.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.51 / $116.51 / $186.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.05 / $85.05 / $163.26
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.52 / $186.44 / $354.24
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.80 / $146.80 / $152.19
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.47 / $89.47 / $346.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.95 / $101.15 / $173.93
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $85.40 / $367.30
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.51 / $116.51 / $186.44
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.05 / $85.05 / $266.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.44 / $206.93 / $206.93
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.44 / $206.93 / $218.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.67 / $92.18 / $107.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.06 / $108.46 / $180.77