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Indiana rates for HCPCS 71275

Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$87.51 / $102.17 / $130.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.76 / $319.92 / $477.07
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.81 / $88.09 / $190.04
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$170.48 / $212.93 / $364.62
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.15 / $207.15 / $414.00
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.86 / $69.08 / $119.73
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$163.90 / $163.90 / $221.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.45 / $359.32 / $556.94
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.13 / $94.32 / $141.47
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$212.00 / $265.00 / $397.50
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.81 / $213.01 / $336.62
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$98.41 / $98.41 / $98.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.18 / $501.62 / $903.28
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.37 / $113.51 / $199.23
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$192.50 / $389.72 / $670.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.10 / $414.68 / $735.96
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$80.78 / $97.97 / $172.69
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$186.81 / $325.68 / $591.33