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Michigan rates for HCPCS 0486T

Optical coherence tomography (OCT) of middle ear, with interpretation and report; bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.56 / $55.56 / $55.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.56 / $55.56 / $83.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.34 / $35.34 / $35.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.27 / $35.34 / $44.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.62 / $65.62 / $65.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.31 / $40.18 / $147.31
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.56 / $174.99 / $174.99
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.56 / $174.99 / $218.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.83 / $4,056.00 / $6,036.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.34 / $82.08 / $122.38