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Michigan rates for HCPCS L5828

Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,031.56 / $2,031.56 / $2,031.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,720.49 / $2,031.56 / $2,196.48
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,668.01 / $2,668.01 / $2,668.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,384.26 / $10,727.51 / $19,538.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,379.47 / $3,557.34 / $4,802.41
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,203.12 / $2,280.62 / $2,312.27
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,845.87 / $2,845.87 / $2,845.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,117.90 / $2,117.90 / $2,117.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,546.07 / $2,957.86 / $5,154.84
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,031.56 / $2,570.69 / $2,570.69
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,012.80 / $2,570.69 / $3,735.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,158.59 / $2,632.43 / $3,027.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,409.12 / $1,700.63 / $2,605.67