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Illinois rates for HCPCS 73201

Computed tomography, upper extremity; with contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$57.54 / $95.50 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $234.42 / $512.86
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.48 / $85.11 / $204.17
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$144.54 / $208.93 / $416.87
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $173.78 / $173.78
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$40.74 / $42.66 / $58.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $199.53 / $446.68
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$72.44 / $72.44 / $72.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $302.00 / $501.19
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $75.86 / $112.20
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$141.25 / $223.87 / $407.38
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $416.87 / $1,412.54
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.57 / $109.65 / $426.58
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$169.82 / $316.23 / $1,047.13
Hally Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $245.47 / $263.03
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.07 / $67.61 / $70.79
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$169.82 / $177.83 / $190.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $302.00 / $446.68
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.48 / $69.18 / $107.15
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$154.88 / $229.09 / $346.74