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Michigan rates for HCPCS L6642

Upper Extremity Addition Excursion Amplifier Lever Type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$198.73 / $198.73 / $198.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.15 / $198.73 / $198.73
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$526.69 / $1,049.36 / $1,911.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.58 / $347.98 / $469.77
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.64 / $208.76 / $226.19
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.38 / $278.38 / $278.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.10 / $225.10 / $225.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.10 / $225.10 / $403.50
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$198.73 / $251.47 / $251.47
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.73 / $251.47 / $391.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $112.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.15 / $172.06 / $200.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.51 / $166.36 / $232.51