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Michigan rates for HCPCS L2768

Orthotic side bar disconnect device, per bar

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.65 / $337.52 / $412.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.45 / $89.65 / $89.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$237.58 / $473.36 / $862.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.12 / $156.97 / $211.91
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.58 / $102.03 / $102.60
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.58 / $125.58 / $125.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.06 / $99.06 / $99.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.06 / $99.06 / $181.88
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.43 / $337.52 / $412.78
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.31 / $113.43 / $164.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.25 / $116.16 / $133.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.78 / $73.72 / $110.96