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Michigan rates for HCPCS L5520

Preparatory, below knee (BK) PTB type socket, nonalignable system, pylon, no cover, SACH foot, thermoplastic or equal, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,088.27 / $1,088.27 / $1,088.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$906.90 / $1,088.27 / $1,114.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.26 / $5,746.56 / $10,466.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,810.33 / $1,905.61 / $2,572.57
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,121.91 / $1,121.91 / $1,238.65
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,524.49 / $1,524.49 / $1,524.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,232.72 / $1,232.72 / $1,232.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,232.72 / $1,232.72 / $2,209.13
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,088.27 / $1,377.09 / $1,377.09
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,088.27 / $1,377.09 / $2,005.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,198.62 / $1,410.15 / $1,621.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.58 / $911.00 / $1,363.89