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Michigan rates for HCPCS L8417

Prosthetic Sheath/Sock Including A Gel Cushion Layer Below Knee Or Above Knee Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.85 / $51.85 / $51.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.21 / $51.85 / $51.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.43 / $273.82 / $498.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.26 / $90.80 / $122.58
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.56 / $59.02 / $59.33
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.64 / $72.64 / $72.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.66 / $50.66 / $50.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.66 / $50.66 / $105.38
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.85 / $65.61 / $65.61
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.40 / $65.61 / $95.34
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.09 / $67.19 / $77.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.71 / $43.40 / $64.98