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Michigan rates for HCPCS L5678

Additions to lower extremity, below knee (BK), joint covers, pair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.22 / $27.22 / $27.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.16 / $27.22 / $27.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.14 / $143.72 / $261.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.28 / $47.66 / $64.34
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.98 / $30.98 / $30.98
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.13 / $38.13 / $38.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.78 / $29.78 / $29.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.77 / $29.78 / $55.13
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.22 / $34.44 / $34.44
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.22 / $34.44 / $51.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.92 / $35.27 / $40.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.80 / $23.77 / $36.64