go back

Michigan rates for HCPCS L5643

Addition to lower extremity, hip disarticulation, flexible inner socket, external frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,381.10 / $1,381.10 / $1,381.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$985.24 / $1,381.10 / $1,381.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,660.34 / $7,292.81 / $13,282.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,297.44 / $2,418.36 / $3,264.79
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,214.27 / $1,214.27 / $1,571.93
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,934.69 / $1,934.69 / $1,934.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,167.30 / $1,167.30 / $1,167.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,167.30 / $1,167.30 / $2,803.50
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,381.10 / $1,747.61 / $1,747.61
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,381.10 / $1,747.61 / $2,539.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,467.46 / $1,789.59 / $2,058.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.65 / $1,135.66 / $1,608.66