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Michigan rates for HCPCS 95930

Visual evoked potential (VEP) checkerboard or flash testing, central nervous system except glaucoma, with interpretation and report

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.75 / $74.75 / $791.15
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$21.33 / $21.34 / $21.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.21 / $90.42 / $166.05
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.67 / $18.67 / $28.45
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$45.68 / $76.12 / $147.55
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.52 / $59.52 / $63.82
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.00 / $34.00 / $34.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.23 / $205.66 / $429.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.23 / $93.67 / $113.39
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.76 / $28.76 / $28.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.96 / $136.97 / $287.75
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$15.73 / $27.55 / $76.25
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$42.04 / $107.81 / $229.10
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.75 / $145.82 / $791.15
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$17.26 / $17.26 / $21.34
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.44 / $118.81 / $168.97
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.73 / $19.84 / $28.46
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$48.89 / $90.34 / $147.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.70 / $52.11 / $86.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.84 / $112.22 / $159.21
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$17.22 / $21.05 / $30.58
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$48.72 / $88.64 / $136.77