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Michigan rates for HCPCS L0861

Addition to halo procedure, replacement liner/interface material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.31 / $148.31 / $148.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.19 / $148.31 / $148.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$393.08 / $783.15 / $1,426.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.71 / $259.70 / $350.60
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.75 / $168.81 / $169.72
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.76 / $207.76 / $207.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.00 / $168.00 / $168.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.64 / $173.53 / $334.25
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.31 / $187.67 / $187.67
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.31 / $187.67 / $292.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.62 / $121.96 / $183.56