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Michigan rates for HCPCS L5968

Addition To Lower Limb Prosthesis Multiaxial Ankle With Swing Phase Active Dorsiflexion Feature

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,505.30 / $2,505.30 / $2,505.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,087.75 / $2,505.30 / $2,505.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,639.82 / $13,229.08 / $24,094.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,167.54 / $4,386.88 / $5,922.29
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,783.14 / $2,851.47 / $2,866.96
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,509.50 / $3,509.50 / $3,509.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,448.80 / $2,448.80 / $2,448.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,448.80 / $2,448.80 / $5,085.75
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,505.30 / $3,170.16 / $3,170.16
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,505.30 / $3,170.16 / $4,934.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.81 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,629.27 / $2,097.19 / $3,100.81