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Michigan rates for HCPCS L2795

Addition to lower extremity orthosis, knee control, full kneecap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.43 / $56.43 / $56.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.36 / $56.43 / $62.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.57 / $298.00 / $542.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.88 / $98.82 / $133.41
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.22 / $63.21 / $64.23
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.06 / $79.06 / $79.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.69 / $62.81 / $62.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.69 / $62.81 / $114.38
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.43 / $71.39 / $71.39
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.76 / $71.39 / $103.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.96 / $73.13 / $84.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.40 / $47.24 / $70.70