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Alaska rates for HCPCS 73701

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$172.18 / $306.22 / $306.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.70 / $338.16 / $670.11
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.07 / $58.49 / $244.98
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$224.62 / $279.66 / $425.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.13 / $616.63 / $825.00
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$82.42 / $188.96 / $247.50
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$171.71 / $427.66 / $577.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.00 / $492.00 / $1,079.21
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$131.80 / $161.84 / $399.58
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$257.94 / $333.81 / $679.64
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$633.75 / $795.00 / $1,222.88
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$203.75 / $220.05 / $366.54
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$430.00 / $587.50 / $851.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.36 / $667.00 / $1,218.08
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$177.81 / $246.00 / $366.54
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$437.50 / $577.50 / $946.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.07 / $587.25 / $1,201.22
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.00 / $244.02 / $388.81
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$304.14 / $460.68 / $840.06