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Michigan rates for HCPCS L8415

Prosthetic sheath, upper limb, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.69 / $14.69 / $14.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.57 / $14.69 / $16.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.94 / $77.59 / $141.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.44 / $25.73 / $34.74
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.72 / $16.72 / $17.80
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.58 / $20.58 / $20.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.30 / $16.30 / $16.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.30 / $16.30 / $30.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.69 / $18.59 / $18.59
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.69 / $18.59 / $27.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.61 / $19.04 / $21.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.70 / $12.83 / $19.78