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Virginia 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
$108.18 / $118.30 / $282.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.81 / $416.94 / $736.19
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$105.87 / $118.30 / $212.03
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$229.43 / $296.79 / $524.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.37 / $428.76 / $588.04
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$93.73 / $119.87 / $164.40
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$238.74 / $308.89 / $423.65
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.40 / $653.54 / $2,315.00
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$116.96 / $136.72 / $238.06
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$327.45 / $405.47 / $705.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.21 / $443.44 / $878.79
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.29 / $141.41 / $260.58
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$215.76 / $302.11 / $613.16
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.13 / $387.76 / $478.23
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$97.29 / $116.75 / $143.99
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$225.84 / $273.74 / $342.18
Medcost
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$141.88 / $164.45 / $215.11
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.00 / $302.00 / $617.52
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.69 / $367.64 / $906.60
Sentara
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$111.39 / $137.87 / $232.36
Sentara
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$202.70 / $303.91 / $599.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.47 / $412.37 / $717.90
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.44 / $142.87 / $223.86
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$198.67 / $274.54 / $512.67