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Michigan rates for HCPCS 65290

Repair of wound, extraocular muscle, tendon and/or Tenon's capsule

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $4,073.80 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $562.34 / $831.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $446.68 / $446.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $1,071.52 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $512.86 / $1,047.13
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $4,073.80 / $5,754.40
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $562.34 / $776.25
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $457.09 / $575.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $6,309.57 / $10,471.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $562.34 / $724.44