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Michigan rates for HCPCS L5695

Addition to lower extremity, above knee (AK), pelvic control, sleeve suspension, neoprene or equal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.78 / $111.78 / $111.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.58 / $111.78 / $112.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.25 / $590.24 / $1,075.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.94 / $195.73 / $264.24
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.22 / $130.63 / $148.47
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.58 / $156.58 / $156.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.31 / $122.31 / $122.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.31 / $122.31 / $226.88
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.78 / $141.44 / $141.44
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.78 / $141.44 / $205.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.76 / $144.84 / $166.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.38 / $97.65 / $150.47