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Virginia rates for HCPCS 73201

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$48.98 / $89.13 / $354.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $223.87 / $512.86
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $81.28 / $173.78
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$141.25 / $190.55 / $398.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $269.15 / $436.52
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $70.79 / $112.20
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$144.54 / $204.17 / $331.13
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $302.00 / $1,047.13
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.95 / $70.79 / $107.15
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$194.98 / $213.80 / $302.00
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
$173.78 / $316.23 / $537.03
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.66 / $69.18 / $123.03
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$134.90 / $245.47 / $426.58
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $234.42 / $302.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.98 / $61.66 / $77.62
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$144.54 / $173.78 / $229.09
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $457.09 / $478.63
Medcost
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.28 / $102.33 / $117.49
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $338.84
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $281.84 / $891.25
Sentara
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.23 / $74.13 / $123.03
Sentara
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$162.18 / $234.42 / $371.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $281.84 / $467.74
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.15 / $64.57 / $107.15
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$131.83 / $213.80 / $380.19