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Michigan rates for HCPCS 80375

Drug/Substance Definitive Qual/Quant Nos 1-3

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $19.66 / $80.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.00 / $11.00 / $11.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.48 / $11.00 / $14.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.89 / $23.95 / $29.94
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $23.12
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.17 / $23.12 / $26.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.07 / $13.27 / $16.05