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Idaho rates for HCPCS 73200

Computed tomography, upper extremity; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$61.66 / $104.71 / $125.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $186.21 / $457.09
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.67 / $85.11 / $218.78
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$354.81 / $354.81 / $354.81
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$102.33 / $177.83 / $398.11
BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$213.80 / $213.80 / $213.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $288.40 / $398.11
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.86 / $89.13 / $123.03
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$165.96 / $194.98 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $223.87 / $416.87
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.81 / $58.88 / $112.20
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.72 / $154.88 / $295.12
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $912.01
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$380.19 / $380.19 / $380.19
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$354.81 / $354.81 / $524.81
Moda Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$69.18 / $112.20 / $125.89
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $302.00 / $446.68
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $91.20 / $128.82
Moda Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$354.81 / $354.81 / $354.81
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$131.83 / $223.87 / $338.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $102.33
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$213.80 / $213.80 / $213.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $346.74 / $407.38
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.62 / $93.33 / $120.23
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$169.82 / $251.19 / $309.03
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $144.54 / $457.09
Select Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.67 / $44.67 / $104.71
Select Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.72 / $117.49 / $275.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $208.93 / $426.58
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.66 / $53.70 / $102.33
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$109.65 / $154.88 / $323.59