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Michigan rates for HCPCS L5830

Addition Endoskeletal Knee-Shin System Single Axis Pneumatic/ Swing Phase Control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,369.81 / $1,369.81 / $1,369.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,171.19 / $1,369.81 / $1,475.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.43 / $7,233.22 / $13,174.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,278.67 / $2,398.60 / $3,238.11
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,480.38 / $1,559.09 / $1,620.49
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,918.88 / $1,918.88 / $1,918.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,654.54 / $1,654.54 / $1,654.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,654.54 / $1,654.54 / $2,780.63
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,369.81 / $1,733.33 / $1,733.33
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,369.81 / $1,733.33 / $2,518.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,455.46 / $1,774.96 / $2,041.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$946.85 / $1,146.68 / $1,750.88