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Alaska rates for HCPCS 91200

Liver elastography, mechanically induced shear wave (eg, vibration), without imaging, with interpretation and report

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$29.24 / $29.24 / $29.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.77 / $39.35 / $61.20
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$15.02 / $15.58 / $23.91
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$23.74 / $23.76 / $37.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.33 / $61.83 / $114.40
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$12.75 / $33.19 / $49.24
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$16.59 / $37.49 / $71.84
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.59 / $88.32 / $193.16
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.08 / $30.44 / $88.99
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$30.09 / $53.09 / $117.87
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.75 / $124.20 / $202.02
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.75 / $41.85 / $74.77
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$75.00 / $82.35 / $125.06
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.44 / $94.99 / $197.18
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.45 / $50.00 / $76.95
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$51.22 / $90.00 / $136.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.63 / $95.22 / $197.58
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.76 / $39.40 / $85.06
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$31.83 / $54.22 / $112.52