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Michigan rates for HCPCS L5782

Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy-duty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,908.11 / $2,908.11 / $2,908.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,423.42 / $2,908.11 / $2,908.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,707.39 / $15,356.10 / $27,968.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,837.60 / $5,092.22 / $6,874.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,230.58 / $3,309.94 / $3,327.88
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,073.78 / $4,073.78 / $4,073.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,294.10 / $3,294.10 / $3,294.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,294.10 / $3,294.10 / $5,903.25
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,908.11 / $3,679.87 / $3,679.87
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,908.11 / $3,679.87 / $5,727.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.81 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,891.21 / $2,434.40 / $3,644.60