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Missouri rates for HCPCS 73200

Ct Upper Extremity W/O Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$52.33 / $58.00 / $100.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.23 / $184.41 / $688.75
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.61 / $65.23 / $246.46
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$200.41 / $200.41 / $200.41
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$110.45 / $201.03 / $598.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.08 / $121.37 / $242.02
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.88 / $48.98 / $74.44
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$81.63 / $81.63 / $182.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.78 / $194.93 / $436.47
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.69 / $63.94 / $113.08
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$220.17 / $292.39 / $654.70
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.08 / $130.59 / $335.70
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$54.02 / $54.02 / $54.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.93 / $253.33 / $444.68
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.32 / $67.76 / $124.66
Cigna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$231.34 / $231.34 / $231.34
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$101.83 / $182.99 / $333.57
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$341.52 / $442.24 / $442.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.88 / $271.39 / $1,378.78
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.05 / $69.00 / $300.10
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$129.00 / $208.45 / $1,103.98
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.32 / $278.32 / $278.32
Qualchoice
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.61 / $85.61 / $85.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.62 / $244.62 / $412.78
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.20 / $61.15 / $109.09
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$117.25 / $175.88 / $289.22