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Michigan rates for HCPCS 28630

Closed treatment of metatarsophalangeal joint dislocation; without anesthesia

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $144.54 / $239.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $251.19 / $251.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $162.18 / $275.42
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $169.82 / $251.19
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $147.91 / $257.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $154.88 / $213.80