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Michigan rates for HCPCS L5616

Addition to lower extremity, endoskeletal system, above knee (AK), universal multiplex system, friction swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,012.88 / $1,012.88 / $1,012.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$844.07 / $1,012.88 / $1,012.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,684.44 / $5,348.44 / $9,741.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,684.91 / $1,773.59 / $2,394.35
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,059.58 / $1,062.00 / $1,152.83
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,418.87 / $1,418.87 / $1,418.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,018.60 / $1,018.60 / $1,018.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$743.58 / $1,474.71 / $2,570.16
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,012.88 / $1,281.70 / $1,281.70
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,012.88 / $1,281.70 / $1,862.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,076.21 / $1,312.46 / $1,509.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$677.71 / $847.90 / $1,269.41