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Michigan rates for HCPCS L5665

Addition to lower extremity, socket insert, multidurometer, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$399.19 / $399.19 / $399.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.12 / $399.19 / $399.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,057.96 / $2,107.87 / $3,839.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$664.04 / $698.99 / $943.64
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$399.46 / $399.46 / $454.34
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.19 / $559.19 / $559.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$452.18 / $452.18 / $452.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.18 / $452.18 / $810.38
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$399.19 / $505.12 / $505.12
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.19 / $505.12 / $786.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $293.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$696.49 / $819.40 / $819.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.50 / $334.16 / $498.79