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Michigan rates for HCPCS 93922

Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with, transcutaneous oxygen tension measurement at 1-2 levels)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$14.50 / $14.50 / $18.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.75 / $110.92 / $194.71
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.34 / $14.50 / $44.87
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$37.93 / $46.22 / $89.93
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$73.90 / $98.19 / $162.66
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.67 / $67.54 / $98.77
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$8.77 / $11.29 / $17.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.43 / $116.32 / $152.51
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$15.84 / $18.64 / $18.64
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.07 / $111.85 / $111.85
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.32 / $73.11 / $99.48
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$13.54 / $13.54 / $13.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.20 / $109.67 / $235.70
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.78 / $14.96 / $32.88
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$68.45 / $97.53 / $200.92
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$11.70 / $14.50 / $18.28
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.13 / $100.66 / $160.34
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.50 / $14.50 / $33.97
Health Alliance Plan
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$39.56 / $46.22 / $132.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$74.45 / $88.95 / $131.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.04 / $67.28 / $96.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.62 / $108.80 / $158.81
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.69 / $13.93 / $20.82
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$73.63 / $97.96 / $134.10