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Pennsylvania rates for HCPCS 73701

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$54.95 / $112.20 / $204.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $194.98 / $549.54
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.70 / $100.00 / $229.09
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$112.20 / $186.21 / $426.58
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $194.98
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.69 / $74.13 / $102.33
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$102.33 / $102.33 / $144.54
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $269.15 / $478.63
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.95 / $70.79 / $134.90
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$109.65 / $190.55 / $371.54
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$13.49 / $61.66 / $89.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $302.00 / $501.19
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.69 / $67.61 / $114.82
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$112.20 / $218.78 / $380.19
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $223.87 / $281.84
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.95 / $70.79 / $87.10
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$120.23 / $154.88 / $194.98
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $239.88 / $489.78
Geisinger
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $66.07 / $117.49
Geisinger
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$114.82 / $177.83 / $363.08
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $213.80 / $223.87
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$61.66 / $67.61 / $107.15
Highmark BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$204.17 / $204.17 / $213.80
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$54.95 / $102.33 / $199.53
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $269.15 / $575.44
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.48 / $81.28 / $181.97
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$117.49 / $208.93 / $426.58
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $316.23 / $446.68
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$54.95 / $61.66 / $61.66
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $181.97 / $288.40
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.48 / $56.23 / $61.66
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$109.65 / $123.03 / $229.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $239.88 / $389.05
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $60.26 / $97.72
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$112.20 / $165.96 / $302.00