go back

Michigan rates for HCPCS L5595

Preparatory Hip Disarticulation-Hemipelvectomy Pylon No Cover Sach Foot Thermoplastic Or Equal Molded To Patient Model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,158.81 / $3,158.81 / $3,158.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,632.34 / $3,158.81 / $3,158.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,371.82 / $16,679.89 / $30,379.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,254.64 / $5,531.20 / $7,467.12
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,296.53 / $3,313.23 / $3,595.28
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,424.96 / $4,424.96 / $4,424.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,578.08 / $3,578.08 / $3,578.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,612.00 / $4,599.09 / $8,015.63
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,158.81 / $3,997.10 / $3,997.10
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,158.81 / $3,997.10 / $5,807.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,356.33 / $4,093.09 / $4,707.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,009.18 / $2,644.27 / $3,958.79