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Washington rates for HCPCS 73201

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$61.66 / $102.33 / $199.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $269.15 / $645.65
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $79.43 / $204.17
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$141.25 / $208.93 / $436.52
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$40.74 / $87.10 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $371.54 / $660.69
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.71 / $81.28 / $162.18
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$151.36 / $281.84 / $501.19
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$63.10 / $107.15 / $1,000.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $426.58 / $562.34
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.70 / $100.00 / $138.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.55 / $323.59 / $436.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $95.50
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$89.13 / $107.15 / $112.20
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $251.19 / $251.19
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.57 / $97.72 / $123.03
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$186.21 / $302.00 / $416.87
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$74.13 / $74.13 / $74.13
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $467.74 / $602.56
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.13 / $117.49 / $158.49
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$208.93 / $338.84 / $446.68
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$707.95 / $707.95 / $707.95
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $436.52 / $588.84
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.62 / $114.82 / $151.36
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$213.80 / $331.13 / $436.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $269.15 / $588.84
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $61.66 / $144.54
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$141.25 / $199.53 / $436.52
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $239.88 / $398.11
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.70 / $61.66 / $102.33
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$154.88 / $177.83 / $288.40