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Michigan rates for HCPCS L3265

Plastazote sandal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $7.41 / $12.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $151.36 / $288.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $50.12 / $52.48
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $21.88 / $21.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.84 / $28.84 / $28.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $20.89 / $28.84
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $34.67 / $38.90
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $13.18 / $19.95
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.84 / $28.84 / $28.84
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $28.84 / $28.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $8.71 / $11.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.31 / $8.71 / $14.79