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Alaska rates for HCPCS 51726

Complex cystometrogram (ie, calibrated electronic equipment);

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$256.81 / $256.81 / $256.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.01 / $382.87 / $1,534.22
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.67 / $100.63 / $406.15
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$231.34 / $282.23 / $953.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$882.91 / $882.91 / $882.91
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$257.92 / $257.92 / $298.69
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$447.62 / $447.62 / $584.22
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$672.80 / $1,747.20 / $2,207.79
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$202.18 / $324.18 / $707.46
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$470.65 / $609.57 / $1,500.33
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,040.00 / $1,216.34 / $1,707.10
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$312.50 / $362.50 / $541.20
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$727.50 / $881.55 / $1,178.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$377.15 / $1,234.50 / $1,770.62
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$307.50 / $410.85 / $562.11
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$786.00 / $994.00 / $1,220.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$652.86 / $706.34 / $1,501.58
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$118.85 / $240.88 / $554.03
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$411.98 / $701.07 / $947.55