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Illinois rates for HCPCS 74775

Perineogram (eg, vaginogram, for sex determination or extent of anomalies)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $223.87 / $223.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $208.93 / $288.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $323.59 / $758.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $95.50 / $169.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $125.89 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $112.20 / $165.96
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $309.03 / $457.09
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $245.47 / $309.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $199.53 / $575.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $263.03 / $446.68