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Michigan rates for HCPCS C9734

Focused Ultrasound Ablation/Therapeutic Inter- Vention Other Than Uterine Leiomyomata With Magnetic Resonance (Mr) Guidance(Revised 07012013)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,399.57 / $11,399.57 / $11,399.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,476.71 / $19,166.41 / $33,312.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,428.96 / $12,511.70 / $16,241.15
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.95 / $500.44 / $11,399.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $75.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,524.00 / $5,819.00 / $8,339.00