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Texas rates for HCPCS 73201

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$45.71 / $54.95 / $56.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $239.88 / $489.78
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.98 / $67.61 / $173.78
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$131.83 / $186.21 / $323.59
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $173.78 / $398.11
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.66 / $57.54 / $102.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $158.49 / $234.42
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $213.80 / $371.54
Christus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $52.48 / $54.95
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$13.49 / $61.66 / $89.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $275.42 / $524.81
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.71 / $69.18 / $125.89
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$131.83 / $204.17 / $416.87
Lucent Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$501.19 / $501.19 / $501.19
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,698.24 / $1,698.24
Lucent Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$346.74 / $436.52 / $436.52
Lucent Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,380.38
Moda Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$45.71 / $54.95 / $56.23
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $281.84 / $588.84
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $70.79 / $173.78
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$138.04 / $208.93 / $416.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $165.96
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $190.55 / $436.52
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$13.49 / $61.66 / $89.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $275.42 / $524.81
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.71 / $64.57 / $107.15
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$131.83 / $194.98 / $354.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $257.04 / $446.68
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $58.88 / $104.71
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$141.25 / $194.98 / $338.84
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $239.88
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.48 / $54.95 / $64.57
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$138.04 / $138.04 / $173.78