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Vermont rates for HCPCS 73201

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $251.19 / $371.54
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.48 / $75.86 / $204.17
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$151.36 / $204.17 / $295.12
BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$338.84 / $338.84 / $338.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $302.00 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $426.58 / $812.83
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.79 / $81.28 / $173.78
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$204.17 / $354.81 / $645.65
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $891.25
MVP Health Care
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$58.88 / $58.88 / $229.09
MVP Health Care
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$177.83 / $177.83 / $177.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $407.38 / $707.95
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.23 / $75.86 / $186.21
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$162.18 / $245.47 / $524.81