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Utah rates for HCPCS 76391

Magnetic resonance (eg, vibration) elastography

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$61.66 / $61.66 / $61.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $213.80 / $426.58
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.69 / $53.70 / $302.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$131.83 / $165.96 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $275.42 / $588.84
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.65 / $64.57 / $114.82
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$144.54 / $204.17 / $338.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $501.19
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$416.87 / $416.87 / $416.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $398.11 / $489.78
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$72.44 / $95.50 / $123.03
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$223.87 / $295.12 / $371.54
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $309.03 / $407.38
Select Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.86 / $81.28 / $123.03
Select Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$134.90 / $229.09 / $269.15
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $234.42 / $398.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $204.17 / $389.05
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.71 / $48.98 / $93.33
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$147.91 / $154.88 / $295.12