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Tennessee 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
$92.13 / $92.13 / $100.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.53 / $93.84 / $172.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.02 / $184.30 / $184.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.51 / $116.51 / $116.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.05 / $85.05 / $116.51
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.97 / $992.11 / $1,180.80
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,193.23 / $1,203.17 / $1,398.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.99 / $92.18 / $112.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.11 / $100.04 / $140.12