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Michigan rates for HCPCS L5210

Above knee (AK), short prosthesis, no knee joint (stubbies), with foot blocks, no ankle joints, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,989.82 / $1,989.82 / $1,989.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,536.05 / $1,989.82 / $1,989.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,273.64 / $10,507.13 / $19,136.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,310.05 / $3,484.26 / $4,703.75
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,893.11 / $1,893.11 / $2,264.77
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,787.41 / $2,787.41 / $2,787.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.89 / $1,819.89 / $1,819.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.89 / $1,819.89 / $4,039.50
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,989.82 / $2,517.88 / $2,517.88
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,971.45 / $2,517.88 / $3,658.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,114.24 / $2,578.35 / $2,965.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,776.27 / $1,776.27 / $1,776.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,210.83 / $1,636.22 / $2,328.08