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Missouri 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
$10.33 / $10.33 / $12.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.69 / $39.35 / $168.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$10.33 / $13.66 / $62.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$18.77 / $21.58 / $48.18
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.43 / $42.43 / $42.43
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.41 / $13.35 / $14.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.07 / $38.22 / $68.44
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$13.27 / $15.63 / $26.71
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$17.34 / $22.49 / $40.61
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$11.90 / $11.90 / $11.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.69 / $46.89 / $81.66
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$10.64 / $18.48 / $31.51
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$19.35 / $28.97 / $52.14
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$24.22 / $70.00 / $70.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.33 / $49.07 / $195.66
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$13.30 / $19.14 / $69.84
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$20.51 / $29.89 / $129.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.24 / $45.95 / $84.48
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$13.30 / $17.80 / $29.88
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$19.93 / $28.61 / $50.26