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Michigan rates for HCPCS L5646

Addition To Lower Extremity Below Knee Air Flu Id Gel Or Equal Cushion Socket. (Rvsd 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$425.63 / $425.63 / $425.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.83 / $425.63 / $426.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,128.04 / $2,247.50 / $4,093.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$708.03 / $745.29 / $1,006.14
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$427.45 / $427.45 / $484.44
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$596.23 / $596.23 / $596.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$410.92 / $410.92 / $410.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.92 / $410.92 / $864.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$425.63 / $538.57 / $538.57
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.69 / $538.57 / $782.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.23 / $551.51 / $634.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.39 / $356.29 / $533.41