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Michigan rates for HCPCS 51728

Complex cystometrogram (ie, calibrated electronic equipment); with voiding pressure studies (ie, bladder voiding pressure), any technique

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$131.66 / $131.66 / $165.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.04 / $379.34 / $503.30
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$101.56 / $121.40 / $228.45
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$150.02 / $170.00 / $213.01
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$198.49 / $257.76 / $410.83
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$103.02 / $103.02 / $103.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.67 / $316.22 / $562.76
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$138.53 / $162.97 / $162.97
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$378.15 / $378.15 / $378.15
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.74 / $264.33 / $397.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.83 / $379.99 / $758.75
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$95.86 / $121.24 / $214.00
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$205.13 / $288.50 / $541.77
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$104.97 / $104.97 / $165.89
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.17 / $396.67 / $565.54
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.97 / $130.63 / $228.45
Health Alliance Plan
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$150.02 / $170.00 / $213.01
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$202.20 / $260.68 / $399.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.22 / $237.47 / $399.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$341.27 / $407.29 / $577.44
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$118.30 / $143.94 / $189.52
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$221.67 / $265.74 / $400.31