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Michigan rates for HCPCS L5699

All lower extremity prostheses, shoulder harness

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.59 / $140.59 / $140.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.16 / $140.59 / $140.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$372.61 / $742.38 / $1,352.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.87 / $246.18 / $332.34
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.46 / $160.02 / $184.49
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.94 / $196.94 / $196.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.96 / $169.96 / $169.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.07 / $204.70 / $356.72
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.59 / $177.90 / $177.90
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.59 / $177.90 / $258.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.37 / $182.17 / $209.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.04 / $117.69 / $181.63