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Maine rates for HCPCS 74175

Ct Angiography Abdomen W/Contrast/Noncontrast

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$103.62 / $103.62 / $119.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.69 / $392.47 / $476.23
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$82.23 / $91.20 / $132.43
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$206.08 / $310.24 / $380.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.08 / $388.97 / $643.41
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.36 / $115.65 / $176.92
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$188.37 / $278.22 / $466.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.96 / $580.04 / $818.01
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$90.87 / $135.69 / $191.63
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$287.58 / $436.54 / $612.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.76 / $461.80 / $833.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$105.52 / $126.99 / $229.06
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$278.24 / $334.82 / $604.00
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$103.62 / $118.15 / $119.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.69 / $438.48 / $660.95
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$86.74 / $103.62 / $210.94
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$206.08 / $318.13 / $447.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.42 / $468.19 / $763.80
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$91.70 / $129.28 / $213.81
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$214.27 / $288.04 / $549.99