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Michigan rates for HCPCS L5672

Addition To Lower Extremity Below Knee Removable Medial Brim Suspension

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.13 / $246.13 / $246.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.52 / $246.13 / $246.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$652.30 / $1,299.66 / $2,367.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.43 / $430.98 / $581.82
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.64 / $280.14 / $294.79
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.78 / $344.78 / $344.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$297.81 / $297.81 / $297.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.81 / $297.81 / $499.50
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.13 / $311.44 / $311.44
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.60 / $311.44 / $452.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$261.52 / $318.93 / $366.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $206.03 / $304.60