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Illinois 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
$102.33 / $158.49 / $199.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $512.86 / $1,348.96
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.00 / $144.54 / $457.09
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$151.36 / $302.00 / $346.74
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$218.78 / $281.84 / $524.81
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $302.00 / $346.74
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$93.33 / $93.33 / $112.20
Ambetter
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$61.66 / $61.66 / $72.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $331.13 / $676.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $467.74 / $741.31
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.65 / $147.91 / $234.42
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$234.42 / $331.13 / $478.63
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $524.81 / $1,258.93
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.65 / $158.49 / $309.03
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$234.42 / $338.84 / $691.83
Hally Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $407.38 / $446.68
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$117.49 / $123.03 / $138.04
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$263.03 / $275.42 / $309.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $426.58 / $707.95
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.65 / $141.25 / $223.87
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$208.93 / $281.84 / $501.19