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Michigan rates for HCPCS L2622

Addition to lower extremity, pelvic control, hip joint, adjustable flexion, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.95 / $218.95 / $218.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.14 / $218.95 / $223.78
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$580.29 / $1,156.18 / $2,105.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.23 / $383.40 / $517.59
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$224.56 / $249.21 / $251.28
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.72 / $306.72 / $306.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.87 / $215.87 / $215.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$215.87 / $215.87 / $444.38
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.95 / $277.07 / $277.07
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.95 / $277.07 / $431.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $165.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.94 / $180.05 / $270.95