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Michigan rates for HCPCS L5668

Addition to lower extremity, below knee (BK), molded distal cushion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $70.79 / $112.20
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $95.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $416.87 / $794.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $138.04 / $144.54
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $89.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $89.13 / $162.18
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $263.03 / $295.12
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $109.65 / $169.82
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $89.13
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $89.13 / $95.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $109.65 / $165.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $66.07 / $95.50