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Pennsylvania rates for HCPCS 93923

Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional Doppler waveform recording and analysis, at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental volume plethysmography at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental transcutaneous oxygen tension measurements at 3 or more levels), or single level study with provocative functional maneuvers (eg, measurements with postural provocative tests, or measurements with reactive hyperemia)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.35 / $512.16 / $1,262.44
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$22.35 / $25.80 / $69.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.74 / $174.18 / $464.35
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.84 / $23.55 / $56.85
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$54.88 / $62.05 / $110.11
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.22 / $125.24 / $238.50
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.05 / $30.80 / $35.04
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$415.40 / $842.08 / $7,266.14
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$447.02 / $5,000.00 / $77,850.02
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.76 / $200.42 / $288.07
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.15 / $34.72 / $53.89
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$103.62 / $165.70 / $247.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.94 / $262.70 / $449.42
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$24.72 / $24.72 / $24.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.16 / $193.57 / $300.02
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.21 / $27.71 / $45.37
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$102.64 / $166.41 / $261.45
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.44 / $204.28 / $413.38
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.53 / $32.01 / $64.77
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$134.81 / $172.27 / $348.61
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.62 / $379.05 / $701.31
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.34 / $24.06 / $35.21
Highmark BCBS
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$12.41 / $12.41 / $12.41
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.83 / $830.54 / $4,622.84
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.83 / $442.12 / $1,262.44
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$22.35 / $30.87 / $72.95
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.87 / $182.97 / $448.46
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.50 / $29.11 / $58.70
Martin's Point
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$54.88 / $64.48 / $127.55
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$98.57 / $152.75 / $271.43
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.44 / $140.69 / $280.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.25 / $256.16 / $449.42
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$24.72 / $24.72 / $24.72
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.14 / $188.01 / $300.02
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.21 / $27.71 / $48.52
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$103.67 / $161.51 / $264.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.36 / $122.36 / $183.57
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$21.20 / $21.20 / $35.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.43 / $122.36 / $183.57
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.44 / $21.43 / $35.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$99.00 / $101.16 / $148.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.98 / $156.75 / $270.95
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.91 / $27.36 / $45.70
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$99.92 / $134.24 / $222.00