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Washington rates for HCPCS 51726

Complex cystometrogram (ie, calibrated electronic equipment);

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$107.23 / $183.73 / $244.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.75 / $421.10 / $715.11
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$78.81 / $107.23 / $219.28
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$202.00 / $310.98 / $495.83
Asuris Northwest Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$110.99 / $165.55 / $516.30
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.83 / $750.32 / $2,600.48
Asuris Northwest Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$118.07 / $206.67 / $697.13
Asuris Northwest Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$307.69 / $543.65 / $1,903.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.69 / $641.62 / $976.46
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.27 / $172.57 / $250.28
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$231.42 / $469.05 / $715.51
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$103.97 / $187.03 / $807.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.83 / $532.41 / $799.69
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$103.97 / $177.62 / $215.72
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$219.83 / $375.55 / $595.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.27 / $269.62 / $608.50
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$127.89 / $163.08 / $166.60
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.93 / $160.93 / $527.90
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$98.40 / $139.08 / $184.50
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$233.16 / $308.37 / $437.51
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$110.99 / $110.99 / $113.34
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.83 / $687.85 / $844.51
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$118.07 / $189.46 / $232.45
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$307.17 / $498.39 / $612.05
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$516.30 / $516.30 / $1,906.19
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.88 / $592.32 / $797.84
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$113.19 / $163.04 / $219.60
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$307.69 / $429.29 / $578.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.65 / $652.96 / $872.81
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$106.92 / $170.11 / $240.41
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$255.20 / $461.51 / $632.40