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Wisconsin rates for HCPCS 73201

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

Facilitymedian $151 · 10th–90th $107$5010%10%20%10th90th$151Professionalmedian $186 · 10th–90th $58$5620%5%10th90th$186$10.0$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$107.15 / $114.82 / $151.36
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $251.19 / $478.63
Aetna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$52.48 / $85.11 / $181.97
Aetna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$144.54 / $208.93 / $363.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $316.23 / $1,174.90
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$53.70 / $85.11 / $309.03
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$147.91 / $229.09 / $870.96
Cigna
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$144.54 / $169.82 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $524.81 / $831.76
Cigna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$58.88 / $128.82 / $223.87
Cigna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$165.96 / $407.38 / $616.60
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $446.68 / $616.60
DeanCare
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$100.00 / $120.23 / $162.18
DeanCare
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$275.42 / $323.59 / $446.68
Medica
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$512.86 / $512.86 / $512.86
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $489.78 / $1,621.81
Medica
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$60.26 / $120.23 / $346.74
Medica
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$190.55 / $380.19 / $1,318.26
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $302.00
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $489.78 / $794.33
Network Health
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$75.86 / $128.82 / $208.93
Network Health
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$229.09 / $363.08 / $575.44
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $501.19 / $1,047.13
Quartz
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$128.82 / $501.19 / $501.19
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $1,071.52 / $1,659.59
Quartz
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$79.43 / $288.40 / $346.74
Quartz
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$213.80 / $794.33 / $1,380.38
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $549.54
Security Health
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$144.54 / $144.54 / $144.54
Security Health
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$407.38 / $407.38 / $407.38
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $1,230.27 / $1,479.11
Security Health
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$186.21 / $194.98 / $316.23
Security Health
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$524.81 / $588.84 / $977.24
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $707.95 / $1,584.89
United
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$87.10 / $194.98 / $354.81
United
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$165.96 / $302.00 / $588.84