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Missouri rates for HCPCS 93922

Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with, transcutaneous oxygen tension measurement at 1-2 levels)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$12.00 / $14.16 / $28.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.75 / $115.56 / $375.32
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.21 / $14.80 / $44.10
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$38.25 / $43.19 / $292.64
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$60.88 / $84.36 / $180.24
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.52 / $77.27 / $92.79
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$8.52 / $13.18 / $16.76
Ambetter
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$23.20 / $23.20 / $23.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $113.15 / $177.85
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$12.51 / $16.00 / $26.54
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$68.87 / $99.10 / $162.43
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$13.54 / $13.54 / $13.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.29 / $123.40 / $218.11
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.82 / $17.17 / $31.74
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$67.20 / $107.30 / $197.76
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$27.12 / $125.86 / $125.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.62 / $125.50 / $768.54
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.69 / $18.26 / $267.48
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$73.63 / $111.11 / $698.48
Qualchoice
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.35 / $16.35 / $16.35
Qualchoice
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$26.68 / $26.68 / $26.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.14 / $106.43 / $202.36
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.35 / $16.05 / $27.49
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$73.52 / $92.04 / $156.72