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Illinois rates for HCPCS 91200

Liver Elastography W/O Imag W/I&R

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$10.77 / $15.57 / $21.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.71 / $39.35 / $155.19
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$10.23 / $14.00 / $58.75
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$18.48 / $22.29 / $35.86
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.86 / $25.86 / $48.13
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$8.77 / $12.56 / $17.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.61 / $30.77 / $79.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.49 / $43.30 / $69.17
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$10.40 / $15.84 / $27.32
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$19.34 / $27.79 / $43.51
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.97 / $49.95 / $270.85
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$12.04 / $16.75 / $132.57
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$21.96 / $28.82 / $126.96
Hally Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.08 / $36.47 / $39.85
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$12.60 / $12.86 / $13.61
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$22.30 / $23.21 / $26.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.24 / $32.34 / $41.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.10 / $47.79 / $74.95
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$13.30 / $18.30 / $30.13
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$20.73 / $28.14 / $50.67