go back

Michigan rates for HCPCS L5570

Preparatory Above Knee - Knee Disarticulation Ischial Level Socket Non-Alignable System Pylon No Cover Sach Foot Thermoplastic Or Equal Direct Formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,562.05 / $1,562.05 / $1,562.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,279.08 / $1,562.05 / $1,562.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,139.93 / $8,248.33 / $15,022.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,598.46 / $2,735.22 / $3,692.55
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,576.42 / $1,576.42 / $1,777.89
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,188.17 / $2,188.17 / $2,188.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,769.38 / $1,769.38 / $1,769.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,769.38 / $1,769.38 / $3,171.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,562.05 / $1,976.59 / $1,976.59
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,562.05 / $1,976.59 / $2,871.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,720.45 / $2,024.06 / $2,327.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,008.28 / $1,307.59 / $1,918.95