go back

Michigan rates for HCPCS A4623

Tracheostomy Inner Cannula. (Rvsd 1/1/04) Ecial Coverage Instructions Apply. See Cim: 65-16)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.98 / $6.98 / $6.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.63 / $6.98 / $6.98
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.33 / $9.00 / $9.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.86 / $27.62 / $50.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.69 / $9.16 / $12.37
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.05 / $5.05 / $5.05
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.33 / $7.33 / $7.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $5.50 / $6.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.33 / $5.67 / $7.61
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.61 / $6.61 / $6.98
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.76 / $6.61 / $9.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.46 / $4.33 / $6.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.04 / $4.30 / $6.55