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Michigan rates for HCPCS L5672

Addition to lower extremity, below knee (BK), removable medial brim suspension

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $245.47 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $213.80 / $302.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $1,288.25 / $2,454.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $426.58 / $457.09
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $234.42 / $234.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $295.12 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $295.12 / $501.19
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $812.83 / $912.01
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $338.84 / $524.81
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $295.12 / $295.12
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $295.12 / $309.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $346.74 / $489.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $204.17 / $288.40