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Michigan rates for HCPCS L5702

Replacement, socket, hip disarticulation, including hip joint, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,306.50 / $3,306.50 / $3,306.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,657.82 / $3,306.50 / $3,306.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,763.24 / $17,459.75 / $31,799.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,500.32 / $5,789.81 / $7,816.24
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,396.19 / $3,514.26 / $3,763.38
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,631.85 / $4,631.85 / $4,631.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,745.37 / $3,745.37 / $3,745.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,734.12 / $4,814.12 / $8,390.16
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,306.50 / $4,183.99 / $4,183.99
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,275.97 / $4,183.99 / $6,594.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,513.25 / $4,284.46 / $4,927.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,167.94 / $2,767.90 / $4,125.99