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Michigan rates for HCPCS L8512

Gelatin Capsules Or Equivalent For Use With Tracheoesophageal Voiceprosthesis Replacement Only Per 10

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.50 / $1.50 / $1.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $1.50 / $1.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $8.00 / $14.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.50 / $2.63 / $3.55
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.65 / $1.71 / $1.72
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.10 / $2.10 / $2.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.08 / $2.08 / $2.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.08 / $2.08 / $3.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.50 / $1.91 / $1.91
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.50 / $1.91 / $2.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.06 / $1.56 / $1.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.26 / $1.86