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Michigan rates for HCPCS L8042

Orbital prosthesis, provided by a nonphysician

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,083.09 / $2,314.55 / $2,314.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,978.94 / $2,083.09 / $2,314.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,134.28 / $12,221.83 / $22,259.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,850.23 / $4,052.87 / $5,471.37
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,033.04 / $2,502.66 / $2,643.71
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,296.94 / $3,080.19 / $3,242.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,214.74 / $3,214.74 / $3,214.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,708.01 / $3,214.74 / $4,698.38
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,314.55 / $2,928.78 / $2,928.78
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,083.09 / $2,928.78 / $4,558.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,503.90 / $1,937.53 / $2,900.71