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Michigan rates for HCPCS L5988

Addition To Lower Limb Prosthesis Vertical Shock Reducing Pylon Feature

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,377.26 / $1,377.26 / $1,377.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,147.72 / $1,377.26 / $1,377.26
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,411.64 / $2,411.64 / $2,411.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,650.17 / $7,272.54 / $13,245.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,291.06 / $2,411.64 / $3,255.71
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,530.01 / $1,567.57 / $1,576.06
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,929.31 / $1,929.31 / $1,929.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,346.19 / $1,346.19 / $1,346.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,346.19 / $1,346.19 / $2,796.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,377.26 / $1,742.76 / $1,742.76
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,377.26 / $1,742.76 / $2,532.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,463.38 / $1,784.61 / $2,052.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$895.67 / $1,152.92 / $1,704.63