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Michigan rates for HCPCS L5647

Addition to lower extremity, below knee (BK), suction socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$545.24 / $545.24 / $1,535.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$466.19 / $545.24 / $618.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.08 / $2,879.14 / $5,243.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$907.01 / $954.75 / $1,288.91
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$620.59 / $620.59 / $620.59
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$763.80 / $763.80 / $763.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$596.58 / $596.58 / $596.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.50 / $793.85 / $1,383.75
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$689.94 / $1,224.29 / $1,535.27
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$545.24 / $689.94 / $1,097.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$565.75 / $689.95 / $793.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $629.41 / $717.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.93 / $476.31 / $733.98