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Michigan rates for HCPCS L5631

Addition to lower extremity, above knee (AK) or knee disarticulation, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.17 / $301.17 / $805.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.50 / $301.17 / $341.75
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.52 / $395.52 / $395.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$798.19 / $1,590.31 / $2,896.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.99 / $527.36 / $711.94
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$342.78 / $342.78 / $418.70
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.89 / $421.89 / $421.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.53 / $329.53 / $329.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.53 / $329.53 / $611.25
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$381.09 / $719.55 / $805.90
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.17 / $381.09 / $553.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.00 / $390.25 / $448.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.25 / $263.08 / $405.42