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Utah 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
$147.91 / $147.91 / $147.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $380.19 / $831.76
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$97.72 / $125.89 / $524.81
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$208.93 / $257.04 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $436.52 / $776.25
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$120.23 / $144.54 / $223.87
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$223.87 / $288.40 / $549.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $60.26 / $954.99
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $575.44 / $1,288.25
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$131.83 / $199.53 / $234.42
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$331.13 / $389.05 / $467.74
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $602.56 / $707.95
Select Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.33 / $186.21 / $218.78
Select Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$218.78 / $416.87 / $478.63
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $371.54 / $645.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $380.19 / $724.44
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.00 / $125.89 / $190.55
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$199.53 / $257.04 / $446.68