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Michigan rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.32 / $88.32 / $985.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.59 / $88.32 / $88.32
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.99 / $154.65 / $154.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.08 / $466.36 / $849.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.91 / $154.65 / $208.78
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.10 / $100.52 / $101.05
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.72 / $123.72 / $123.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.03 / $100.03 / $100.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.03 / $100.03 / $179.25
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.74 / $881.71 / $985.61
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.43 / $111.74 / $162.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.84 / $114.44 / $131.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.43 / $73.93 / $109.29