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Michigan rates for HCPCS L5706

Custom Shaped Protective Cover Knee Disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$771.04 / $771.04 / $771.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.78 / $771.04 / $771.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,043.49 / $4,071.42 / $7,415.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,282.60 / $1,350.12 / $1,822.66
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$732.45 / $819.50 / $877.58
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,080.09 / $1,080.09 / $1,080.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$957.73 / $957.73 / $957.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$957.73 / $957.73 / $1,565.25
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$771.04 / $975.67 / $975.67
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$763.93 / $975.67 / $1,417.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$819.25 / $999.09 / $1,148.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$595.23 / $595.23 / $595.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.76 / $645.45 / $902.12