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Michigan rates for HCPCS L5964

Addition, endoskeletal system, above knee (AK), flexible protective outer surface covering system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $776.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $660.69 / $977.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $4,073.80 / $7,762.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,348.96 / $1,412.54
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $724.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $707.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $707.95 / $1,584.89
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $2,570.40 / $2,884.03
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,071.52 / $1,659.59
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $707.95
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $707.95 / $741.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $1,071.52 / $1,513.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $630.96 / $912.01