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Michigan rates for HCPCS L5200

Above knee (AK), molded socket, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,506.08 / $2,506.08 / $2,506.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,088.40 / $2,506.08 / $2,506.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,641.89 / $13,233.21 / $24,102.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.84 / $4,388.25 / $5,924.14
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,595.73 / $2,852.36 / $2,853.66
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,510.60 / $3,510.60 / $3,510.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,728.17 / $2,728.17 / $2,728.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,991.56 / $3,648.74 / $6,359.06
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,506.08 / $3,171.14 / $3,171.14
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,506.08 / $3,171.14 / $4,607.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,662.79 / $3,247.31 / $3,734.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,648.40 / $2,097.86 / $3,137.22