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Michigan rates for HCPCS 0654T

Esophagogastroduodenoscopy, flexible, transnasal; with insertion of intraluminal tube or catheter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $2,877.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.98 / $134.90 / $149.60
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.12 / $271.12 / $271.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,675.93 / $2,538.09 / $6,085.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.12 / $221.18 / $263.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.62 / $294.62 / $294.62
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$962.13 / $2,877.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.12 / $134.90 / $172.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $50.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,050.00 / $3,640.00 / $6,036.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.50 / $193.37 / $265.33