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Michigan rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$441.25 / $441.25 / $441.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.07 / $441.25 / $441.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,169.47 / $2,330.03 / $4,243.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$734.03 / $772.66 / $1,043.08
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$397.73 / $420.75 / $502.23
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.13 / $618.13 / $618.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $499.82 / $499.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$499.82 / $499.82 / $895.88
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$441.25 / $558.36 / $558.36
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.85 / $558.36 / $811.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.85 / $571.77 / $657.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.78 / $382.03 / $445.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.92 / $369.38 / $513.96