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Michigan rates for HCPCS 77011

Computed tomography guidance for stereotactic localization

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$77.62 / $79.43 / $79.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $275.42 / $501.19
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $63.10 / $154.88
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$128.82 / $194.98 / $457.09
Ambetter
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$41.69 / $41.69 / $41.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $323.59 / $346.74
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$97.72 / $97.72 / $97.72
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$251.19 / $251.19 / $251.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $302.00 / $489.78
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.65 / $79.43 / $128.82
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$144.54 / $257.04 / $371.54
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$50.12 / $125.89 / $138.04
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $281.84 / $436.52
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.86 / $66.07 / $97.72
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$158.49 / $234.42 / $389.05
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $295.12 / $489.78
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.65 / $79.43 / $134.90
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$141.25 / $208.93 / $371.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $354.81 / $707.95
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.70 / $64.57 / $100.00
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$151.36 / $245.47 / $645.65