go back

Michigan rates for HCPCS L5639

Addition To Lower Extremity Below Knee Wood Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$768.50 / $768.50 / $768.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$657.07 / $768.50 / $872.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,036.77 / $4,058.03 / $7,391.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,278.40 / $1,345.68 / $1,816.67
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$874.69 / $874.69 / $890.69
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,076.54 / $1,076.54 / $1,076.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.50 / $870.50 / $870.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.50 / $870.50 / $1,560.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$768.50 / $972.46 / $972.46
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$768.50 / $972.46 / $1,412.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.55 / $995.80 / $1,145.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.46 / $671.35 / $1,034.53