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Missouri 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
$96.09 / $110.72 / $179.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.00 / $374.41 / $1,567.56
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.70 / $99.01 / $354.05
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$182.47 / $291.01 / $1,053.10
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.38 / $213.55 / $445.46
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.73 / $89.92 / $128.81
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$319.42 / $319.42 / $319.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $351.27 / $785.64
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$90.01 / $107.87 / $192.58
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$174.26 / $240.12 / $607.07
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
$244.48 / $448.45 / $858.00
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.59 / $122.74 / $218.83
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$174.41 / $330.26 / $676.05
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$627.76 / $804.96 / $804.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.83 / $528.14 / $3,183.14
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$93.11 / $123.60 / $1,009.00
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$213.95 / $407.74 / $2,699.58
Qualchoice
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$156.43 / $156.43 / $156.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.01 / $441.07 / $811.73
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$88.46 / $110.56 / $186.22
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$208.77 / $319.19 / $550.69