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Michigan rates for HCPCS L5840

Addition, endoskeletal knee-shin system, four-bar linkage or multiaxial, pneumatic swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,688.58 / $2,688.58 / $2,688.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,161.14 / $2,688.58 / $2,688.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,125.55 / $14,196.84 / $25,857.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,472.41 / $4,707.80 / $6,355.53
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,737.22 / $2,857.53 / $3,060.07
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,766.24 / $3,766.24 / $3,766.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,364.97 / $3,364.97 / $3,364.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,364.97 / $3,364.97 / $5,457.75
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,688.58 / $3,402.09 / $3,402.09
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,688.58 / $3,402.09 / $5,295.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $1,299.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,691.28 / $2,250.63 / $3,369.48