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Michigan rates for HCPCS 95810

Polysom 6/>Yrs Sleep 4/> Addl Param Attnd

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$132.50 / $132.50 / $166.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.53 / $720.28 / $1,026.17
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$115.95 / $132.51 / $326.29
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$247.60 / $327.29 / $427.46
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$484.78 / $587.25 / $826.26
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.98 / $606.98 / $606.98
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.03 / $113.94 / $148.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.27 / $620.84 / $849.47
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$123.88 / $145.74 / $145.74
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$644.28 / $644.28 / $644.28
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.96 / $546.28 / $766.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.34 / $962.16 / $1,663.16
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.81 / $211.15 / $299.61
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$488.97 / $784.52 / $1,363.54
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$119.30 / $132.50 / $166.96
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.73 / $673.80 / $950.14
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$117.82 / $132.50 / $275.51
Health Alliance Plan
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$289.89 / $327.29 / $427.46
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$501.32 / $539.58 / $744.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.02 / $486.21 / $775.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$621.10 / $745.03 / $1,047.65
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$120.45 / $153.61 / $212.35
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$486.31 / $591.12 / $791.27