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Michigan rates for HCPCS L5642

Addition to lower extremity, above knee (AK), leather socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$468.25 / $468.25 / $468.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.25 / $468.25 / $468.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,241.00 / $2,472.55 / $4,503.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$778.92 / $819.92 / $1,106.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$483.36 / $485.49 / $532.95
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.94 / $655.94 / $655.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.41 / $530.41 / $530.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.20 / $681.75 / $1,188.28
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$468.25 / $592.52 / $592.52
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.25 / $592.52 / $860.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.52 / $606.74 / $697.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.16 / $391.97 / $586.85