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Michigan rates for HCPCS L2628

Addition to lower extremity, pelvic control, metal frame, reciprocating hip joint and cables

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,077.92 / $1,077.92 / $1,077.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$988.09 / $1,077.92 / $1,077.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,856.82 / $5,691.88 / $10,366.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,793.11 / $1,887.48 / $2,548.10
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,226.85 / $1,301.56 / $1,477.46
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,509.98 / $1,509.98 / $1,509.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,179.41 / $1,179.41 / $1,179.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,179.40 / $1,179.41 / $2,188.13
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,077.92 / $1,363.98 / $1,363.98
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,069.81 / $1,363.98 / $2,122.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,145.32 / $1,396.74 / $1,606.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$737.30 / $902.33 / $1,350.91