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Tennessee 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
$130.86 / $445.50 / $992.55
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$19.82 / $22.25 / $53.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.66 / $145.69 / $276.63
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.82 / $22.48 / $41.21
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$58.77 / $65.43 / $92.28
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$98.55 / $119.49 / $197.70
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.34 / $124.67 / $229.45
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$15.78 / $21.12 / $38.19
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$91.56 / $91.56 / $91.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.20 / $175.07 / $265.63
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.09 / $27.92 / $42.75
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$93.17 / $152.30 / $231.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.03 / $302.70 / $387.15
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
$119.77 / $169.92 / $293.62
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.84 / $27.68 / $47.22
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$100.56 / $145.88 / $257.07
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$259.14 / $696.92 / $696.92
Lucent Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$48.94 / $176.87 / $176.87
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,098.83 / $1,173.20 / $1,205.33
Lucent Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$310.41 / $310.41 / $310.41
Lucent Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$925.73 / $1,048.79 / $1,077.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.48 / $158.76 / $264.61
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.47 / $26.74 / $49.56
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$101.01 / $139.86 / $232.82