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Michigan rates for HCPCS 61791

Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); trigeminal medullary tract

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,476.63 / $4,112.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$971.72 / $1,476.63 / $1,533.43
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,582.19 / $1,846.89 / $2,515.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.52 / $1,080.31 / $2,722.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,007.04 / $1,423.82 / $2,196.51
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,207.97 / $4,112.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,207.97 / $1,330.34 / $1,800.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.94 / $844.89 / $1,385.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,248.00 / $5,048.00 / $7,355.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,226.28 / $1,405.33 / $1,894.47