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Utah rates for HCPCS 76511

Ophthalmic ultrasound, diagnostic; quantitative A-scan only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$56.23 / $56.23 / $56.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $72.44 / $281.84
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.18 / $39.81 / $81.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $97.72 / $158.49
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.31 / $56.23 / $93.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $66.07
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$199.53 / $199.53 / $199.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $131.83 / $208.93
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.98 / $70.79 / $112.20
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $87.10 / $131.83
Select Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.88 / $54.95 / $79.43
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $58.88 / $112.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $75.86 / $125.89
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.67 / $42.66 / $67.61