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Michigan rates for HCPCS L5622

Addition to lower extremity, test socket, knee disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.35 / $275.35 / $275.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.43 / $275.35 / $275.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$729.76 / $1,453.97 / $2,648.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.04 / $482.15 / $650.90
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$282.83 / $313.39 / $331.24
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.72 / $385.72 / $385.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$274.54 / $274.54 / $274.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.41 / $400.90 / $698.91
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.35 / $348.41 / $348.41
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.30 / $348.41 / $506.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.56 / $356.79 / $410.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.90 / $230.50 / $340.77