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Michigan rates for HCPCS 0354T

Optical coherence tomography of breast, surgical cavity; interpretation and report, real-time or referred

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.32 / $178.98 / $238.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.68 / $119.32 / $435.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.93 / $140.93 / $140.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.18 / $343.18 / $343.18
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.32 / $281.89 / $942.54
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.32 / $942.54 / $1,129.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.40 / $1,004.73 / $1,500.61