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Michigan rates for HCPCS L5614

Addition to lower extremity, exoskeletal system, above knee (AK), knee disarticulation, four-bar linkage, with pneumatic swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,163.39 / $1,163.39 / $1,163.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$969.49 / $1,163.39 / $1,163.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,083.34 / $6,143.20 / $11,188.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,935.28 / $2,037.14 / $2,750.14
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,292.39 / $1,324.14 / $1,331.31
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,629.71 / $1,629.71 / $1,629.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,317.79 / $1,317.79 / $1,317.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,317.79 / $1,317.79 / $2,361.75
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,163.39 / $1,472.12 / $1,472.12
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,163.39 / $1,472.12 / $2,291.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$756.58 / $973.88 / $1,439.90