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Pennsylvania 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
$89.13 / $181.97 / $316.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $380.19 / $1,548.82
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.79 / $117.49 / $316.23
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$162.18 / $229.09 / $562.34
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.81 / $72.44 / $131.83
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$229.09 / $229.09 / $229.09
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $389.05 / $389.05
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.11 / $114.82 / $218.78
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$173.78 / $181.97 / $724.44
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$20.89 / $97.72 / $141.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $489.78 / $891.25
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.57 / $107.15 / $181.97
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.55 / $363.08 / $676.08
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $354.81 / $446.68
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.11 / $109.65 / $134.90
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.55 / $245.47 / $309.03
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $398.11 / $794.33
Geisinger
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.86 / $104.71 / $190.55
Geisinger
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$181.97 / $288.40 / $562.34
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $407.38 / $407.38
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.13 / $102.33 / $131.83
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$89.13 / $173.78 / $309.03
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $398.11 / $851.14
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.43 / $117.49 / $251.19
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$169.82 / $281.84 / $602.56
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $323.59 / $707.95
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$85.11 / $85.11 / $97.72
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $251.19 / $309.03
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.18 / $85.11 / $97.72
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$165.96 / $169.82 / $288.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $398.11 / $645.65
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.13 / $95.50 / $151.36
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$199.53 / $281.84 / $512.86