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Michigan rates for HCPCS L6687

Upper extremity addition, frame type socket, below elbow or wrist disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$395.37 / $395.37 / $395.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.49 / $395.37 / $395.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.85 / $2,087.73 / $3,802.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$657.69 / $692.31 / $934.62
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $450.00 / $450.00
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.85 / $553.85 / $553.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.60 / $432.60 / $432.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.60 / $432.60 / $802.50
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$395.37 / $500.30 / $500.30
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.37 / $500.30 / $778.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.09 / $512.30 / $589.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.71 / $456.41 / $532.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.83 / $345.39 / $532.23