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Arizona rates for HCPCS 51728

Complex cystometrogram (ie, calibrated electronic equipment); with voiding pressure studies (ie, bladder voiding pressure), any technique

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$95.50 / $95.50 / $95.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $512.86 / $1,584.89
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$97.72 / $131.83 / $457.09
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$151.36 / $302.00 / $426.58
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$208.93 / $281.84 / $575.44
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $316.23 / $416.87
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.18 / $112.20 / $128.82
Ambetter
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$56.23 / $97.72 / $112.20
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$288.40 / $288.40 / $288.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $316.23 / $891.25
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.11 / $95.50 / $269.15
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$194.98 / $218.78 / $630.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $407.38 / $724.44
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.00 / $134.90 / $218.78
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.55 / $281.84 / $489.78
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$263.03 / $263.03 / $467.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $380.19 / $2,691.53
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$95.50 / $125.89 / $776.25
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$181.97 / $257.04 / $1,905.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $346.74 / $676.08
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$93.33 / $114.82 / $208.93
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$181.97 / $234.42 / $478.63