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Maryland rates for HCPCS 74175

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$74.13 / $89.13 / $100.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $371.54 / $1,513.56
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.86 / $128.82 / $295.12
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$169.82 / $229.09 / $562.34
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $398.11 / $478.63
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.62 / $112.20 / $123.03
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$295.12 / $323.59 / $380.19
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$141.25 / $141.25 / $141.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $446.68 / $851.14
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.07 / $100.00 / $190.55
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.55 / $331.13 / $660.69
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $371.54 / $512.86
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.18 / $95.50 / $128.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$234.42 / $275.42 / $407.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $398.11 / $691.83
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.70 / $93.33 / $158.49
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$199.53 / $309.03 / $562.34
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $323.59 / $426.58
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.10 / $100.00 / $128.82
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.55 / $218.78 / $295.12