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Michigan rates for HCPCS L5920

Addition, endoskeletal system, above knee (AK) or hip disarticulation, alignable system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.70 / $363.70 / $987.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.95 / $363.70 / $412.70
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.63 / $477.63 / $477.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$963.90 / $1,920.45 / $3,497.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$605.00 / $636.84 / $859.73
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$413.95 / $413.95 / $413.95
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$509.47 / $509.47 / $509.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$397.94 / $397.94 / $397.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.94 / $397.94 / $738.38
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$460.21 / $881.71 / $987.01
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.70 / $460.21 / $668.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.43 / $471.26 / $541.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.76 / $317.70 / $489.58