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Maryland rates for HCPCS 73200

Computed tomography, upper extremity; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$40.74 / $48.98 / $56.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $162.18 / $724.44
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.71 / $85.11 / $204.17
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$43.65 / $199.53 / $630.96
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$102.33 / $173.78 / $630.96
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $208.93 / $263.03
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.48 / $61.66 / $70.79
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$151.36 / $169.82 / $194.98
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$75.86 / $75.86 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $245.47 / $446.68
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.31 / $57.54 / $104.71
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$104.71 / $186.21 / $346.74
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $194.98 / $288.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $53.70 / $72.44
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$120.23 / $141.25 / $229.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $218.78 / $363.08
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.90 / $51.29 / $91.20
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$104.71 / $158.49 / $281.84
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $186.21 / $245.47
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $54.95 / $70.79
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$112.20 / $131.83 / $177.83