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CT Scan of Abdomen and Pelvis, With Contrast

Nationwide rates for HCPCS 74177

A detailed cross-sectional imaging exam of the abdomen and pelvis using X-rays, performed after injecting a contrast dye into a vein. The contrast highlights blood vessels and helps make organs and abnormal tissue, such as tumors or areas of inflammation, easier to see and distinguish from surrounding tissue. It's commonly used to investigate abdominal pain, infection, or suspected masses.

Rates data updated October 2026.

How much does CT Scan of Abdomen and Pelvis, With Contrast cost?

$347

Typical negotiated rate. Nationwide, October 2026.

Insurers have agreed to pay about $347 for this service. The price depends on where it is billed: about $339 from a physician practice, and about $977 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 103 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$339$251 to $457
FacilityA hospital or hospital-owned outpatient department$977$479 to $2,455

How much rates vary

Facilitymedian $977 · 10th to 90th $331 to $3,715Professionalmedian $339 · 10th to 90th $112 to $741
$20$100$500$2Kfacility $977professional $339

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$338.84
Median
$1,513.56
Typical High
$4,073.80
Aetna
Setting
Facility
Modifier
26 · Professional part
Typical Low
$75.86
Median
$104.71
Typical High
$173.78
Aetna
Setting
Facility
Modifier
TC · Technical part
Typical Low
$218.78
Median
$288.40
Typical High
$812.83
Aetna
Setting
Professional
Modifier
None (both parts)
Typical Low
$275.42
Median
$354.81
Typical High
$602.56
Aetna
Setting
Professional
Modifier
26 · Professional part
Typical Low
$69.18
Median
$91.20
Typical High
$158.49
Aetna
Setting
Professional
Modifier
TC · Technical part
Typical Low
$213.80
Median
$263.03
Typical High
$426.58
AllWays Health Partners
Setting
Facility
Modifier
None
Typical Low
$269.15
Median
$1,096.48
Typical High
$1,348.96
AllWays Health Partners
Setting
Facility
Modifier
26 · Professional part
Typical Low
$75.86
Median
$331.13
Typical High
$346.74
AllWays Health Partners
Setting
Facility
Modifier
TC · Technical part
Typical Low
$194.98
Median
$933.25
Typical High
$1,000.00
AllWays Health Partners
Setting
Professional
Modifier
None (both parts)
Typical Low
$288.40
Median
$758.58
Typical High
$2,089.30
AllWays Health Partners
Setting
Professional
Modifier
26 · Professional part
Typical Low
$79.43
Median
$199.53
Typical High
$549.54
AllWays Health Partners
Setting
Professional
Modifier
TC · Technical part
Typical Low
$218.78
Median
$588.84
Typical High
$2,630.27
Ambetter
Setting
Professional
Modifier
None (both parts)
Typical Low
$208.93
Median
$245.47
Typical High
$512.86
Ambetter
Setting
Professional
Modifier
26 · Professional part
Typical Low
$66.07
Median
$85.11
Typical High
$151.36
Ambetter
Setting
Professional
Modifier
TC · Technical part
Typical Low
$144.54
Median
$229.09
Typical High
$354.81
AmeriHealth
Setting
Facility
Modifier
None
Typical Low
$446.68
Median
$676.08
Typical High
$3,090.30
AmeriHealth
Setting
Facility
Modifier
TC · Technical part
Typical Low
$446.68
Median
$851.14
Typical High
$3,388.44
AmeriHealth
Setting
Professional
Modifier
None (both parts)
Typical Low
$416.87
Median
$416.87
Typical High
$724.44
AmeriHealth
Setting
Professional
Modifier
26 · Professional part
Typical Low
$102.33
Median
$104.71
Typical High
$229.09
AmeriHealth
Setting
Professional
Modifier
TC · Technical part
Typical Low
$309.03
Median
$316.23
Typical High
$501.19
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$288.40
Median
$707.95
Typical High
$1,548.82
Anthem BCBS
Setting
Professional
Modifier
None (both parts)
Typical Low
$295.12
Median
$371.54
Typical High
$691.83
Anthem BCBS
Setting
Professional
Modifier
26 · Professional part
Typical Low
$75.86
Median
$95.50
Typical High
$177.83
Anthem BCBS
Setting
Professional
Modifier
TC · Technical part
Typical Low
$213.80
Median
$269.15
Typical High
$501.19
Asuris Northwest Health
Setting
Facility
Modifier
None
Typical Low
$223.87
Median
$1,023.29
Typical High
$2,238.72
Asuris Northwest Health
Setting
Professional
Modifier
None (both parts)
Typical Low
$446.68
Median
$2,089.30
Typical High
$2,570.40
Asuris Northwest Health
Setting
Professional
Modifier
26 · Professional part
Typical Low
$117.49
Median
$549.54
Typical High
$691.83
Asuris Northwest Health
Setting
Professional
Modifier
TC · Technical part
Typical Low
$323.59
Median
$630.96
Typical High
$2,630.27
Aultcare
Setting
Facility
Modifier
None
Typical Low
$831.76
Median
$831.76
Typical High
$831.76
Aultcare
Setting
Professional
Modifier
None (both parts)
Typical Low
$323.59
Median
$323.59
Typical High
$562.34
AvMed
Setting
Facility
Modifier
None
Typical Low
$144.54
Median
$288.40
Typical High
$549.54
AvMed
Setting
Professional
Modifier
None (both parts)
Typical Low
$177.83
Median
$223.87
Typical High
$281.84
BCBS Alabama
Setting
Facility
Modifier
None
Typical Low
$457.09
Median
$467.74
Typical High
$467.74
BCBS Arizona
Setting
Facility
Modifier
None
Typical Low
$204.17
Median
$933.25
Typical High
$1,412.54
BCBS Arizona
Setting
Professional
Modifier
None (both parts)
Typical Low
$346.74
Median
$346.74
Typical High
$660.69
BCBS Arizona
Setting
Professional
Modifier
26 · Professional part
Typical Low
$85.11
Median
$85.11
Typical High
$165.96
BCBS Arizona
Setting
Professional
Modifier
TC · Technical part
Typical Low
$263.03
Median
$263.03
Typical High
$501.19
BCBS Arkansas
Setting
Facility
Modifier
None
Typical Low
$363.08
Median
$363.08
Typical High
$501.19
BCBS Arkansas
Setting
Professional
Modifier
None (both parts)
Typical Low
$346.74
Median
$346.74
Typical High
$446.68
BCBS Arkansas
Setting
Professional
Modifier
26 · Professional part
Typical Low
$107.15
Median
$107.15
Typical High
$138.04
BCBS Arkansas
Setting
Professional
Modifier
TC · Technical part
Typical Low
$239.88
Median
$239.88
Typical High
$309.03
BCBS Idaho
Setting
Facility
Modifier
None
Typical Low
$575.44
Median
$1,348.96
Typical High
$2,137.96
BCBS Idaho
Setting
Professional
Modifier
None (both parts)
Typical Low
$489.78
Median
$575.44
Typical High
$691.83
BCBS Idaho
Setting
Professional
Modifier
26 · Professional part
Typical Low
$141.25
Median
$165.96
Typical High
$204.17
BCBS Idaho
Setting
Professional
Modifier
TC · Technical part
Typical Low
$346.74
Median
$407.38
Typical High
$489.78
BCBS Illinois
Setting
Facility
Modifier
None
Typical Low
$501.19
Median
$1,698.24
Typical High
$4,168.69
BCBS Illinois
Setting
Professional
Modifier
None (both parts)
Typical Low
$112.20
Median
$354.81
Typical High
$616.60
BCBS Kansas
Setting
Facility
Modifier
None
Typical Low
$457.09
Median
$457.09
Typical High
$478.63
BCBS Kansas
Setting
Professional
Modifier
None (both parts)
Typical Low
$549.54
Median
$549.54
Typical High
$549.54
BCBS Kansas City
Setting
Facility
Modifier
None
Typical Low
$269.15
Median
$371.54
Typical High
$660.69
BCBS Kansas City
Setting
Professional
Modifier
None (both parts)
Typical Low
$316.23
Median
$331.13
Typical High
$426.58
BCBS Kansas City
Setting
Professional
Modifier
26 · Professional part
Typical Low
$91.20
Median
$93.33
Typical High
$123.03
BCBS Kansas City
Setting
Professional
Modifier
TC · Technical part
Typical Low
$223.87
Median
$234.42
Typical High
$302.00
BCBS Louisiana
Setting
Facility
Modifier
None
Typical Low
$416.87
Median
$741.31
Typical High
$1,000.00
BCBS Louisiana
Setting
Professional
Modifier
None (both parts)
Typical Low
$416.87
Median
$446.68
Typical High
$501.19
BCBS Louisiana
Setting
Professional
Modifier
26 · Professional part
Typical Low
$100.00
Median
$112.20
Typical High
$128.82
BCBS Louisiana
Setting
Professional
Modifier
TC · Technical part
Typical Low
$316.23
Median
$338.84
Typical High
$363.08
BCBS Massachusetts
Setting
Facility
Modifier
None
Typical Low
$602.56
Median
$1,096.48
Typical High
$1,698.24
BCBS Massachusetts
Setting
Professional
Modifier
None (both parts)
Typical Low
$436.52
Median
$537.03
Typical High
$1,230.27
BCBS Massachusetts
Setting
Professional
Modifier
26 · Professional part
Typical Low
$93.33
Median
$93.33
Typical High
$158.49
BCBS Michigan
Setting
Facility
Modifier
None
Typical Low
$354.81
Median
$537.03
Typical High
$912.01
BCBS Michigan
Setting
Professional
Modifier
None (both parts)
Typical Low
$128.82
Median
$467.74
Typical High
$501.19
BCBS Michigan
Setting
Professional
Modifier
26 · Professional part
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
BCBS Michigan
Setting
Professional
Modifier
TC · Technical part
Typical Low
$354.81
Median
$354.81
Typical High
$354.81
BCBS Minnesota
Setting
Facility
Modifier
None
Typical Low
$512.86
Median
$1,412.54
Typical High
$1,995.26
BCBS Minnesota
Setting
Professional
Modifier
None (both parts)
Typical Low
$489.78
Median
$645.65
Typical High
$954.99
BCBS Minnesota
Setting
Professional
Modifier
26 · Professional part
Typical Low
$138.04
Median
$181.97
Typical High
$269.15
BCBS Minnesota
Setting
Professional
Modifier
TC · Technical part
Typical Low
$354.81
Median
$489.78
Typical High
$707.95
BCBS Mississippi
Setting
Facility
Modifier
None
Typical Low
$549.54
Median
$549.54
Typical High
$602.56
BCBS Mississippi
Setting
Professional
Modifier
None (both parts)
Typical Low
$501.19
Median
$501.19
Typical High
$501.19
BCBS Montana
Setting
Facility
Modifier
None
Typical Low
$933.25
Median
$933.25
Typical High
$2,089.30
BCBS Montana
Setting
Professional
Modifier
None (both parts)
Typical Low
$134.90
Median
$134.90
Typical High
$489.78
BCBS Nebraska
Setting
Facility
Modifier
None
Typical Low
$912.01
Median
$2,754.23
Typical High
$2,884.03
BCBS Nebraska
Setting
Professional
Modifier
26 · Professional part
Typical Low
$144.54
Median
$154.88
Typical High
$162.18
BCBS Nebraska
Setting
Professional
Modifier
TC · Technical part
Typical Low
$354.81
Median
$389.05
Typical High
$416.87
BCBS New Mexico
Setting
Facility
Modifier
None
Typical Low
$436.52
Median
$1,584.89
Typical High
$2,398.83
BCBS New Mexico
Setting
Professional
Modifier
None (both parts)
Typical Low
$61.66
Median
$213.80
Typical High
$316.23
BCBS North Carolina
Setting
Facility
Modifier
None
Typical Low
$1,096.48
Median
$1,318.26
Typical High
$2,089.30
BCBS North Carolina
Setting
Professional
Modifier
26 · Professional part
Typical Low
$151.36
Median
$223.87
Typical High
$281.84
BCBS North Carolina
Setting
Professional
Modifier
TC · Technical part
Typical Low
$416.87
Median
$501.19
Typical High
$707.95
BCBS North Dakota
Setting
Facility
Modifier
None
Typical Low
$562.34
Median
$1,819.70
Typical High
$2,238.72
BCBS North Dakota
Setting
Professional
Modifier
None (both parts)
Typical Low
$524.81
Median
$676.08
Typical High
$794.33
BCBS North Dakota
Setting
Professional
Modifier
26 · Professional part
Typical Low
$147.91
Median
$190.55
Typical High
$223.87
BCBS North Dakota
Setting
Professional
Modifier
TC · Technical part
Typical Low
$380.19
Median
$489.78
Typical High
$575.44
BCBS Oklahoma
Setting
Facility
Modifier
None
Typical Low
$501.19
Median
$691.83
Typical High
$977.24
BCBS Oklahoma
Setting
Professional
Modifier
None (both parts)
Typical Low
$93.33
Median
$309.03
Typical High
$416.87
BCBS Rhode Island
Setting
Facility
Modifier
None
Typical Low
$275.42
Median
$309.03
Typical High
$645.65
BCBS Rhode Island
Setting
Professional
Modifier
None (both parts)
Typical Low
$331.13
Median
$446.68
Typical High
$707.95
BCBS Rhode Island
Setting
Professional
Modifier
26 · Professional part
Typical Low
$87.10
Median
$120.23
Typical High
$151.36
BCBS Rhode Island
Setting
Professional
Modifier
TC · Technical part
Typical Low
$223.87
Median
$275.42
Typical High
$323.59
BCBS South Carolina
Setting
Facility
Modifier
None
Typical Low
$977.24
Median
$2,290.87
Typical High
$3,467.37
BCBS South Carolina
Setting
Facility
Modifier
TC · Technical part
Typical Low
$870.96
Median
$870.96
Typical High
$870.96
BCBS South Carolina
Setting
Professional
Modifier
None (both parts)
Typical Low
$281.84
Median
$776.25
Typical High
$1,023.29
BCBS South Carolina
Setting
Professional
Modifier
26 · Professional part
Typical Low
$81.28
Median
$199.53
Typical High
$275.42
BCBS South Carolina
Setting
Professional
Modifier
TC · Technical part
Typical Low
$199.53
Median
$549.54
Typical High
$676.08
BCBS Tennessee
Setting
Professional
Modifier
None (both parts)
Typical Low
$208.93
Median
$363.08
Typical High
$676.08
BCBS Tennessee
Setting
Professional
Modifier
26 · Professional part
Typical Low
$79.43
Median
$109.65
Typical High
$190.55
BCBS Tennessee
Setting
Professional
Modifier
TC · Technical part
Typical Low
$190.55
Median
$288.40
Typical High
$489.78
BCBS Texas
Setting
Facility
Modifier
None
Typical Low
$416.87
Median
$1,288.25
Typical High
$2,884.03
BCBS Texas
Setting
Professional
Modifier
None (both parts)
Typical Low
$70.79
Median
$239.88
Typical High
$371.54
BCBS Vermont
Setting
Facility
Modifier
None
Typical Low
$1,778.28
Median
$3,388.44
Typical High
$4,786.30
BCBS Vermont
Setting
Professional
Modifier
None (both parts)
Typical Low
$380.19
Median
$380.19
Typical High
$1,348.96
BCBS Wyoming
Setting
Professional
Modifier
None (both parts)
Typical Low
$794.33
Median
$1,230.27
Typical High
$1,230.27
BCBS Wyoming
Setting
Professional
Modifier
26 · Professional part
Typical Low
$218.78
Median
$338.84
Typical High
$338.84
BCBS Wyoming
Setting
Professional
Modifier
TC · Technical part
Typical Low
$562.34
Median
$870.96
Typical High
$870.96
Baylor Scott & White
Setting
Facility
Modifier
None
Typical Low
$446.68
Median
$707.95
Typical High
$1,023.29
Baylor Scott & White
Setting
Professional
Modifier
None (both parts)
Typical Low
$288.40
Median
$295.12
Typical High
$398.11
Blue Shield
Setting
Facility
Modifier
None
Typical Low
$501.19
Median
$2,089.30
Typical High
$3,890.45
Blue Shield
Setting
Professional
Modifier
None (both parts)
Typical Low
$257.04
Median
$389.05
Typical High
$691.83
Blue Shield
Setting
Professional
Modifier
26 · Professional part
Typical Low
$75.86
Median
$109.65
Typical High
$186.21
Blue Shield
Setting
Professional
Modifier
TC · Technical part
Typical Low
$186.21
Median
$281.84
Typical High
$489.78
CDPHP
Setting
Professional
Modifier
None (both parts)
Typical Low
$125.89
Median
$338.84
Typical High
$467.74
Capital Blue Cross
Setting
Facility
Modifier
None
Typical Low
$912.01
Median
$5,011.87
Typical High
$5,011.87
Capital Blue Cross
Setting
Facility
Modifier
TC · Technical part
Typical Low
$1,380.38
Median
$1,737.80
Typical High
$5,011.87
Capital Blue Cross
Setting
Professional
Modifier
None (both parts)
Typical Low
$295.12
Median
$489.78
Typical High
$741.31
Capital Blue Cross
Setting
Professional
Modifier
26 · Professional part
Typical Low
$87.10
Median
$147.91
Typical High
$218.78
Capital Blue Cross
Setting
Professional
Modifier
TC · Technical part
Typical Low
$208.93
Median
$338.84
Typical High
$512.86
CareFirst
Setting
Professional
Modifier
None (both parts)
Typical Low
$288.40
Median
$389.05
Typical High
$436.52
CareFirst
Setting
Professional
Modifier
26 · Professional part
Typical Low
$100.00
Median
$109.65
Typical High
$112.20
CareFirst
Setting
Professional
Modifier
TC · Technical part
Typical Low
$302.00
Median
$323.59
Typical High
$323.59
CareSource
Setting
Facility
Modifier
None
Typical Low
$81.28
Median
$213.80
Typical High
$371.54
CareSource
Setting
Professional
Modifier
None (both parts)
Typical Low
$81.28
Median
$213.80
Typical High
$363.08
Central California Alliance for Health
Setting
Professional
Modifier
None (both parts)
Typical Low
$338.84
Median
$446.68
Typical High
$446.68
Christus
Setting
Facility
Modifier
None
Typical Low
$363.08
Median
$363.08
Typical High
$363.08
Christus
Setting
Professional
Modifier
26 · Professional part
Typical Low
$83.18
Median
$87.10
Typical High
$87.10
Cigna
Setting
Facility
Modifier
None
Typical Low
$457.09
Median
$741.31
Typical High
$1,513.56
Cigna
Setting
Facility
Modifier
26 · Professional part
Typical Low
$21.38
Median
$128.82
Typical High
$338.84
Cigna
Setting
Facility
Modifier
TC · Technical part
Typical Low
$50.12
Median
$302.00
Typical High
$912.01
Cigna
Setting
Professional
Modifier
None (both parts)
Typical Low
$239.88
Median
$389.05
Typical High
$794.33
Cigna
Setting
Professional
Modifier
26 · Professional part
Typical Low
$63.10
Median
$102.33
Typical High
$204.17
Cigna
Setting
Professional
Modifier
TC · Technical part
Typical Low
$169.82
Median
$288.40
Typical High
$575.44
Community Health Options
Setting
Facility
Modifier
None
Typical Low
$3,801.89
Median
$3,801.89
Typical High
$3,801.89
Community Health Options
Setting
Professional
Modifier
None (both parts)
Typical Low
$354.81
Median
$407.38
Typical High
$588.84
ConnectiCare
Setting
Professional
Modifier
None (both parts)
Typical Low
$371.54
Median
$436.52
Typical High
$512.86
Contra Costa Health
Setting
Professional
Modifier
None
Typical Low
$281.84
Median
$398.11
Typical High
$537.03
Contra Costa Health
Setting
Professional
Modifier
26 · Professional part
Typical Low
$79.43
Median
$95.50
Typical High
$128.82
Contra Costa Health
Setting
Professional
Modifier
TC · Technical part
Typical Low
$204.17
Median
$302.00
Typical High
$407.38
DeanCare
Setting
Facility
Modifier
None
Typical Low
$346.74
Median
$1,659.59
Typical High
$2,290.87
DeanCare
Setting
Facility
Modifier
TC · Technical part
Typical Low
$1,479.11
Median
$1,819.70
Typical High
$2,290.87
DeanCare
Setting
Professional
Modifier
None (both parts)
Typical Low
$562.34
Median
$776.25
Typical High
$851.14
DeanCare
Setting
Professional
Modifier
26 · Professional part
Typical Low
$158.49
Median
$218.78
Typical High
$239.88
DeanCare
Setting
Professional
Modifier
TC · Technical part
Typical Low
$407.38
Median
$549.54
Typical High
$616.60
Denver HMP
Setting
Facility
Modifier
None
Typical Low
$338.84
Median
$436.52
Typical High
$549.54
Denver HMP
Setting
Professional
Modifier
None (both parts)
Typical Low
$588.84
Median
$588.84
Typical High
$588.84
Emblem Health
Setting
Facility
Modifier
None
Typical Low
$173.78
Median
$269.15
Typical High
$758.58
Emblem Health
Setting
Professional
Modifier
None (both parts)
Typical Low
$309.03
Median
$363.08
Typical High
$512.86
Emblem Health
Setting
Professional
Modifier
26 · Professional part
Typical Low
$85.11
Median
$97.72
Typical High
$154.88
Emblem Health
Setting
Professional
Modifier
TC · Technical part
Typical Low
$251.19
Median
$263.03
Typical High
$371.54
Excellus BCBS
Setting
Facility
Modifier
None
Typical Low
$109.65
Median
$109.65
Typical High
$109.65
Excellus BCBS
Setting
Facility
Modifier
TC · Technical part
Typical Low
$66.07
Median
$66.07
Typical High
$66.07
Excellus BCBS
Setting
Professional
Modifier
None (both parts)
Typical Low
$263.03
Median
$288.40
Typical High
$501.19
Excellus BCBS
Setting
Professional
Modifier
26 · Professional part
Typical Low
$66.07
Median
$81.28
Typical High
$144.54
Excellus BCBS
Setting
Professional
Modifier
TC · Technical part
Typical Low
$194.98
Median
$204.17
Typical High
$363.08
Fallon Health
Setting
Facility
Modifier
None
Typical Low
$107.15
Median
$309.03
Typical High
$489.78
Fallon Health
Setting
Professional
Modifier
None (both parts)
Typical Low
$109.65
Median
$331.13
Typical High
$501.19
Fidelis
Setting
Professional
Modifier
26 · Professional part
Typical Low
$74.13
Median
$97.72
Typical High
$131.83
Florida Blue
Setting
Facility
Modifier
None
Typical Low
$954.99
Median
$1,949.84
Typical High
$3,019.95
Florida Blue
Setting
Professional
Modifier
None (both parts)
Typical Low
$229.09
Median
$354.81
Typical High
$416.87
Florida Blue
Setting
Professional
Modifier
26 · Professional part
Typical Low
$67.61
Median
$95.50
Typical High
$123.03
Florida Blue
Setting
Professional
Modifier
TC · Technical part
Typical Low
$162.18
Median
$257.04
Typical High
$295.12
Geisinger
Setting
Professional
Modifier
None (both parts)
Typical Low
$245.47
Median
$338.84
Typical High
$630.96
Geisinger
Setting
Professional
Modifier
26 · Professional part
Typical Low
$70.79
Median
$95.50
Typical High
$181.97
Geisinger
Setting
Professional
Modifier
TC · Technical part
Typical Low
$181.97
Median
$245.47
Typical High
$457.09
HMSA
Setting
Professional
Modifier
None (both parts)
Typical Low
$138.04
Median
$851.14
Typical High
$1,000.00
HMSA
Setting
Professional
Modifier
26 · Professional part
Typical Low
$151.36
Median
$154.88
Typical High
$162.18
HMSA
Setting
Professional
Modifier
TC · Technical part
Typical Low
$691.83
Median
$691.83
Typical High
$724.44
Hally Health
Setting
Professional
Modifier
None
Typical Low
$309.03
Median
$457.09
Typical High
$1,737.80
Hally Health
Setting
Professional
Modifier
26 · Professional part
Typical Low
$91.20
Median
$134.90
Typical High
$645.65
Hally Health
Setting
Professional
Modifier
TC · Technical part
Typical Low
$213.80
Median
$331.13
Typical High
$1,023.29
Hally Health
Setting
Facility
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
None (both parts)
Typical Low
$363.08
Median
$371.54
Typical High
$398.11
Harvard Pilgrim
Setting
Professional
Modifier
None (both parts)
Typical Low
$363.08
Median
$537.03
Typical High
$1,000.00
Harvard Pilgrim
Setting
Professional
Modifier
26 · Professional part
Typical Low
$95.50
Median
$141.25
Typical High
$263.03
Harvard Pilgrim
Setting
Professional
Modifier
TC · Technical part
Typical Low
$263.03
Median
$380.19
Typical High
$676.08
Health Alliance Plan
Setting
Facility
Modifier
None
Typical Low
$489.78
Median
$1,949.84
Typical High
$3,467.37
Health Alliance Plan
Setting
Facility
Modifier
26 · Professional part
Typical Low
$112.20
Median
$112.20
Typical High
$204.17
Health Alliance Plan
Setting
Facility
Modifier
TC · Technical part
Typical Low
$269.15
Median
$660.69
Typical High
$4,168.69
Health Alliance Plan
Setting
Professional
Modifier
None (both parts)
Typical Low
$281.84
Median
$371.54
Typical High
$524.81
Health Alliance Plan
Setting
Professional
Modifier
26 · Professional part
Typical Low
$69.18
Median
$112.20
Typical High
$275.42
Health Alliance Plan
Setting
Professional
Modifier
TC · Technical part
Typical Low
$208.93
Median
$275.42
Typical High
$323.59
Health New England
Setting
Facility
Modifier
None
Typical Low
$537.03
Median
$1,659.59
Typical High
$2,818.38
Health New England
Setting
Professional
Modifier
None (both parts)
Typical Low
$123.03
Median
$208.93
Typical High
$691.83
Health Partners
Setting
Facility
Modifier
None
Typical Low
$645.65
Median
$1,047.13
Typical High
$2,454.71
Health Partners
Setting
Facility
Modifier
26 · Professional part
Typical Low
$177.83
Median
$281.84
Typical High
$676.08
Health Partners
Setting
Facility
Modifier
TC · Technical part
Typical Low
$478.63
Median
$758.58
Typical High
$1,778.28
Health Partners
Setting
Professional
Modifier
None (both parts)
Typical Low
$467.74
Median
$524.81
Typical High
$912.01
Health Partners
Setting
Professional
Modifier
26 · Professional part
Typical Low
$128.82
Median
$151.36
Typical High
$251.19
Health Partners
Setting
Professional
Modifier
TC · Technical part
Typical Low
$346.74
Median
$371.54
Typical High
$660.69
Health Smart
Setting
Facility
Modifier
None
Typical Low
$426.58
Median
$426.58
Typical High
$602.56
Health Smart
Setting
Professional
Modifier
None (both parts)
Typical Low
$331.13
Median
$371.54
Typical High
$501.19
HealthNet
Setting
Professional
Modifier
26 · Professional part
Typical Low
$112.20
Median
$186.21
Typical High
$380.19
Highmark BCBS
Setting
Facility
Modifier
None
Typical Low
$457.09
Median
$933.25
Typical High
$2,238.72
Highmark BCBS
Setting
Facility
Modifier
TC · Technical part
Typical Low
$380.19
Median
$891.25
Typical High
$2,511.89
Highmark BCBS
Setting
Professional
Modifier
None (both parts)
Typical Low
$309.03
Median
$371.54
Typical High
$549.54
Highmark BCBS
Setting
Professional
Modifier
26 · Professional part
Typical Low
$91.20
Median
$109.65
Typical High
$194.98
Hometown Health
Setting
Professional
Modifier
None
Typical Low
$2.95
Median
$346.74
Typical High
$478.63
Hometown Health
Setting
Professional
Modifier
26 · Professional part
Typical Low
$0.78
Median
$93.33
Typical High
$141.25
Hometown Health
Setting
Professional
Modifier
TC · Technical part
Typical Low
$2.19
Median
$257.04
Typical High
$346.74
Hometown Health
Setting
Professional
Modifier
None (both parts)
Typical Low
$446.68
Median
$446.68
Typical High
$446.68
Horizon BCBS
Setting
Facility
Modifier
None
Typical Low
$457.09
Median
$977.24
Typical High
$1,995.26
Horizon BCBS
Setting
Professional
Modifier
None (both parts)
Typical Low
$338.84
Median
$389.05
Typical High
$602.56
Horizon BCBS
Setting
Professional
Modifier
26 · Professional part
Typical Low
$87.10
Median
$100.00
Typical High
$131.83
Horizon BCBS
Setting
Professional
Modifier
TC · Technical part
Typical Low
$245.47
Median
$281.84
Typical High
$389.05
Independence Blue Cross
Setting
Facility
Modifier
None
Typical Low
$371.54
Median
$741.31
Typical High
$2,041.74
Independence Blue Cross
Setting
Facility
Modifier
TC · Technical part
Typical Low
$380.19
Median
$851.14
Typical High
$2,041.74
Independence Blue Cross
Setting
Professional
Modifier
None (both parts)
Typical Low
$281.84
Median
$338.84
Typical High
$616.60
Independence Blue Cross
Setting
Professional
Modifier
26 · Professional part
Typical Low
$102.33
Median
$107.15
Typical High
$144.54
Independence Blue Cross
Setting
Professional
Modifier
TC · Technical part
Typical Low
$309.03
Median
$309.03
Typical High
$371.54
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$302.00
Median
$389.05
Typical High
$741.31
Kaiser Permanente
Setting
Professional
Modifier
26 · Professional part
Typical Low
$85.11
Median
$114.82
Typical High
$257.04
Kaiser Permanente
Setting
Professional
Modifier
TC · Technical part
Typical Low
$239.88
Median
$316.23
Typical High
$575.44
Kaiser Permanente
Setting
Professional
Modifier
None (both parts)
Typical Low
$131.83
Median
$407.38
Typical High
$741.31
Lucent Health
Setting
Professional
Modifier
None (both parts)
Typical Low
$2,089.30
Median
$2,089.30
Typical High
$2,570.40
Lucent Health
Setting
Professional
Modifier
26 · Professional part
Typical Low
$549.54
Median
$691.83
Typical High
$691.83
Lucent Health
Setting
Professional
Modifier
TC · Technical part
Typical Low
$2,630.27
Median
$2,630.27
Typical High
$2,630.27
MVP Health Care
Setting
Facility
Modifier
None
Typical Low
$107.15
Median
$257.04
Typical High
$457.09
MVP Health Care
Setting
Professional
Modifier
None (both parts)
Typical Low
$338.84
Median
$338.84
Typical High
$794.33
MVP Health Care
Setting
Professional
Modifier
26 · Professional part
Typical Low
$95.50
Median
$117.49
Typical High
$147.91
MVP Health Care
Setting
Professional
Modifier
TC · Technical part
Typical Low
$245.47
Median
$302.00
Typical High
$407.38
Martin's Point
Setting
Facility
Modifier
None
Typical Low
$354.81
Median
$812.83
Typical High
$1,949.84
Martin's Point
Setting
Facility
Modifier
26 · Professional part
Typical Low
$83.18
Median
$104.71
Typical High
$177.83
Martin's Point
Setting
Facility
Modifier
TC · Technical part
Typical Low
$218.78
Median
$275.42
Typical High
$1,122.02
Martin's Point
Setting
Professional
Modifier
None (both parts)
Typical Low
$295.12
Median
$371.54
Typical High
$512.86
Martin's Point
Setting
Professional
Modifier
26 · Professional part
Typical Low
$81.28
Median
$93.33
Typical High
$134.90
Martin's Point
Setting
Professional
Modifier
TC · Technical part
Typical Low
$213.80
Median
$269.15
Typical High
$354.81
Mass General Brigham
Setting
Facility
Modifier
None
Typical Low
$269.15
Median
$1,096.48
Typical High
$1,348.96
Mass General Brigham
Setting
Facility
Modifier
26 · Professional part
Typical Low
$75.86
Median
$331.13
Typical High
$346.74
Mass General Brigham
Setting
Facility
Modifier
TC · Technical part
Typical Low
$194.98
Median
$933.25
Typical High
$1,000.00
Mass General Brigham
Setting
Professional
Modifier
None (both parts)
Typical Low
$288.40
Median
$758.58
Typical High
$2,089.30
Mass General Brigham
Setting
Professional
Modifier
26 · Professional part
Typical Low
$79.43
Median
$199.53
Typical High
$549.54
Mass General Brigham
Setting
Professional
Modifier
TC · Technical part
Typical Low
$218.78
Median
$588.84
Typical High
$2,630.27
Medcost
Setting
Professional
Modifier
None
Typical Low
$489.78
Median
$616.60
Typical High
$616.60
Medcost
Setting
Professional
Modifier
26 · Professional part
Typical Low
$134.90
Median
$169.82
Typical High
$169.82
Medcost
Setting
Facility
Modifier
None
Typical Low
$281.84
Median
$416.87
Typical High
$2,511.89
Medcost
Setting
Professional
Modifier
None (both parts)
Typical Low
$346.74
Median
$489.78
Typical High
$645.65
Medcost
Setting
Professional
Modifier
26 · Professional part
Typical Low
$117.49
Median
$128.82
Typical High
$316.23
Medcost
Setting
Professional
Modifier
TC · Technical part
Typical Low
$281.84
Median
$363.08
Typical High
$467.74
Medica
Setting
Facility
Modifier
None
Typical Low
$436.52
Median
$1,258.93
Typical High
$3,981.07
Medica
Setting
Facility
Modifier
26 · Professional part
Typical Low
$630.96
Median
$812.83
Typical High
$812.83
Medica
Setting
Facility
Modifier
TC · Technical part
Typical Low
$1,412.54
Median
$2,187.76
Typical High
$4,265.80
Medica
Setting
Professional
Modifier
None (both parts)
Typical Low
$316.23
Median
$758.58
Typical High
$2,089.30
Medica
Setting
Professional
Modifier
26 · Professional part
Typical Low
$91.20
Median
$218.78
Typical High
$549.54
Medica
Setting
Professional
Modifier
TC · Technical part
Typical Low
$229.09
Median
$562.34
Typical High
$2,630.27
Medical Mutual of Ohio
Setting
Facility
Modifier
None
Typical Low
$691.83
Median
$1,258.93
Typical High
$3,235.94
Medical Mutual of Ohio
Setting
Professional
Modifier
None (both parts)
Typical Low
$288.40
Median
$363.08
Typical High
$812.83
Medical Mutual of Ohio
Setting
Professional
Modifier
26 · Professional part
Typical Low
$63.10
Median
$162.18
Typical High
$269.15
Medical Mutual of Ohio
Setting
Professional
Modifier
TC · Technical part
Typical Low
$204.17
Median
$263.03
Typical High
$562.34
Midlands
Setting
Professional
Modifier
None
Typical Low
$630.96
Median
$691.83
Typical High
$758.58
Midlands
Setting
Professional
Modifier
26 · Professional part
Typical Low
$177.83
Median
$199.53
Typical High
$213.80
Midlands
Setting
Professional
Modifier
TC · Technical part
Typical Low
$446.68
Median
$501.19
Typical High
$537.03
Midlands
Setting
Facility
Modifier
None
Typical Low
$1,148.15
Median
$1,148.15
Typical High
$1,659.59
Midlands
Setting
Professional
Modifier
None (both parts)
Typical Low
$562.34
Median
$691.83
Typical High
$891.25
Midlands
Setting
Professional
Modifier
26 · Professional part
Typical Low
$158.49
Median
$199.53
Typical High
$239.88
Midlands
Setting
Professional
Modifier
TC · Technical part
Typical Low
$407.38
Median
$512.86
Typical High
$645.65
Moda Health
Setting
Facility
Modifier
None
Typical Low
$457.09
Median
$2,511.89
Typical High
$6,606.93
Moda Health
Setting
Facility
Modifier
26 · Professional part
Typical Low
$74.13
Median
$104.71
Typical High
$478.63
Moda Health
Setting
Facility
Modifier
TC · Technical part
Typical Low
$245.47
Median
$977.24
Typical High
$3,630.78
Moda Health
Setting
Professional
Modifier
None (both parts)
Typical Low
$269.15
Median
$346.74
Typical High
$758.58
Moda Health
Setting
Professional
Modifier
26 · Professional part
Typical Low
$72.44
Median
$93.33
Typical High
$302.00
Moda Health
Setting
Professional
Modifier
TC · Technical part
Typical Low
$199.53
Median
$245.47
Typical High
$489.78
Molina
Setting
Professional
Modifier
None (both parts)
Typical Low
$37.15
Median
$194.98
Typical High
$457.09
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$109.65
Median
$501.19
Typical High
$630.96
MountainHealth Co-op
Setting
Professional
Modifier
None (both parts)
Typical Low
$72.44
Median
$331.13
Typical High
$660.69
Network Health
Setting
Facility
Modifier
None
Typical Low
$489.78
Median
$489.78
Typical High
$707.95
Network Health
Setting
Professional
Modifier
None (both parts)
Typical Low
$457.09
Median
$562.34
Typical High
$1,122.02
Network Health
Setting
Professional
Modifier
26 · Professional part
Typical Low
$123.03
Median
$141.25
Typical High
$346.74
Network Health
Setting
Professional
Modifier
TC · Technical part
Typical Low
$338.84
Median
$426.58
Typical High
$912.01
Oscar Health
Setting
Professional
Modifier
None (both parts)
Typical Low
$91.20
Median
$275.42
Typical High
$549.54
Pacific Source
Setting
Facility
Modifier
None
Typical Low
$147.91
Median
$416.87
Typical High
$616.60
Pacific Source
Setting
Professional
Modifier
None (both parts)
Typical Low
$181.97
Median
$213.80
Typical High
$549.54
Physicians Health Plan of Northern Indiana
Setting
Facility
Modifier
None
Typical Low
$794.33
Median
$912.01
Typical High
$2,089.30
Physicians Health Plan of Northern Indiana
Setting
Professional
Modifier
None (both parts)
Typical Low
$331.13
Median
$436.52
Typical High
$575.44
Physicians Health Plan of Northern Indiana
Setting
Professional
Modifier
26 · Professional part
Typical Low
$95.50
Median
$123.03
Typical High
$162.18
Physicians Health Plan of Northern Indiana
Setting
Professional
Modifier
TC · Technical part
Typical Low
$239.88
Median
$309.03
Typical High
$407.38
Premera BCBS
Setting
Facility
Modifier
None
Typical Low
$371.54
Median
$436.52
Typical High
$436.52
Premera BCBS
Setting
Professional
Modifier
None (both parts)
Typical Low
$426.58
Median
$426.58
Typical High
$1,258.93
Premera BCBS
Setting
Professional
Modifier
26 · Professional part
Typical Low
$117.49
Median
$117.49
Typical High
$346.74
Premera BCBS
Setting
Professional
Modifier
TC · Technical part
Typical Low
$309.03
Median
$309.03
Typical High
$912.01
Prevea360
Setting
Facility
Modifier
None
Typical Low
$309.03
Median
$602.56
Typical High
$616.60
Priority Health
Setting
Professional
Modifier
None (both parts)
Typical Low
$251.19
Median
$363.08
Typical High
$676.08
Priority Health
Setting
Professional
Modifier
26 · Professional part
Typical Low
$66.07
Median
$97.72
Typical High
$177.83
Priority Health
Setting
Professional
Modifier
TC · Technical part
Typical Low
$173.78
Median
$234.42
Typical High
$501.19
Providence
Setting
Facility
Modifier
None
Typical Low
$309.03
Median
$575.44
Typical High
$1,258.93
Providence
Setting
Professional
Modifier
None (both parts)
Typical Low
$194.98
Median
$331.13
Typical High
$776.25
Providence
Setting
Professional
Modifier
26 · Professional part
Typical Low
$50.12
Median
$85.11
Typical High
$165.96
Providence
Setting
Professional
Modifier
TC · Technical part
Typical Low
$134.90
Median
$234.42
Typical High
$489.78
Qualchoice
Setting
Professional
Modifier
None (both parts)
Typical Low
$537.03
Median
$562.34
Typical High
$588.84
Qualchoice
Setting
Professional
Modifier
26 · Professional part
Typical Low
$109.65
Median
$158.49
Typical High
$173.78
Qualchoice
Setting
Professional
Modifier
TC · Technical part
Typical Low
$354.81
Median
$371.54
Typical High
$389.05
Quartz
Setting
Professional
Modifier
None
Typical Low
$331.13
Median
$660.69
Typical High
$1,380.38
Quartz
Setting
Professional
Modifier
None (both parts)
Typical Low
$416.87
Median
$436.52
Typical High
$1,071.52
Quartz
Setting
Professional
Modifier
26 · Professional part
Typical Low
$125.89
Median
$125.89
Typical High
$302.00
Quartz
Setting
Professional
Modifier
TC · Technical part
Typical Low
$309.03
Median
$316.23
Typical High
$758.58
Regence BlueShield
Setting
Facility
Modifier
None
Typical Low
$707.95
Median
$1,071.52
Typical High
$1,698.24
Regence BlueShield
Setting
Professional
Modifier
None (both parts)
Typical Low
$446.68
Median
$602.56
Typical High
$812.83
Regence BlueShield
Setting
Professional
Modifier
26 · Professional part
Typical Low
$123.03
Median
$162.18
Typical High
$229.09
Regence BlueShield
Setting
Professional
Modifier
TC · Technical part
Typical Low
$323.59
Median
$436.52
Typical High
$602.56
Sanford Health Plan
Setting
Professional
Modifier
None
Typical Low
$389.05
Median
$501.19
Typical High
$588.84
Sanford Health Plan
Setting
Professional
Modifier
26 · Professional part
Typical Low
$107.15
Median
$141.25
Typical High
$165.96
Sanford Health Plan
Setting
Professional
Modifier
TC · Technical part
Typical Low
$275.42
Median
$363.08
Typical High
$426.58
Security Health
Setting
Professional
Modifier
None
Typical Low
$831.76
Median
$831.76
Typical High
$831.76
Security Health
Setting
Professional
Modifier
None (both parts)
Typical Low
$1,000.00
Median
$1,949.84
Typical High
$2,630.27
Security Health
Setting
Professional
Modifier
26 · Professional part
Typical Low
$257.04
Median
$309.03
Typical High
$501.19
Security Health
Setting
Professional
Modifier
TC · Technical part
Typical Low
$602.56
Median
$758.58
Typical High
$1,479.11
Select Health
Setting
Facility
Modifier
None
Typical Low
$281.84
Median
$316.23
Typical High
$1,548.82
Select Health
Setting
Professional
Modifier
None (both parts)
Typical Low
$281.84
Median
$389.05
Typical High
$741.31
Select Health
Setting
Professional
Modifier
26 · Professional part
Typical Low
$79.43
Median
$112.20
Typical High
$213.80
Select Health
Setting
Professional
Modifier
TC · Technical part
Typical Low
$199.53
Median
$275.42
Typical High
$537.03
Sentara
Setting
Facility
Modifier
None
Typical Low
$95.50
Median
$323.59
Typical High
$2,630.27
Sentara
Setting
Professional
Modifier
None (both parts)
Typical Low
$112.20
Median
$354.81
Typical High
$758.58
Sentara
Setting
Professional
Modifier
26 · Professional part
Typical Low
$87.10
Median
$109.65
Typical High
$173.78
Sentara
Setting
Professional
Modifier
TC · Technical part
Typical Low
$245.47
Median
$302.00
Typical High
$501.19
SummaCare
Setting
Professional
Modifier
None (both parts)
Typical Low
$186.21
Median
$239.88
Typical High
$489.78
SummaCare
Setting
Professional
Modifier
26 · Professional part
Typical Low
$81.28
Median
$95.50
Typical High
$151.36
SummaCare
Setting
Professional
Modifier
TC · Technical part
Typical Low
$104.71
Median
$134.90
Typical High
$323.59
Sutter Health Plus
Setting
Professional
Modifier
None (both parts)
Typical Low
$1,096.48
Median
$1,096.48
Typical High
$1,096.48
Sutter Health Plus
Setting
Professional
Modifier
26 · Professional part
Typical Low
$295.12
Median
$295.12
Typical High
$295.12
Sutter Health Plus
Setting
Professional
Modifier
TC · Technical part
Typical Low
$794.33
Median
$794.33
Typical High
$794.33
The Alliance
Setting
Professional
Modifier
None (both parts)
Typical Low
$537.03
Median
$1,584.89
Typical High
$2,137.96
The Alliance
Setting
Professional
Modifier
26 · Professional part
Typical Low
$154.88
Median
$436.52
Typical High
$537.03
The Alliance
Setting
Professional
Modifier
TC · Technical part
Typical Low
$389.05
Median
$645.65
Typical High
$1,621.81
Tufts
Setting
Facility
Modifier
None
Typical Low
$251.19
Median
$436.52
Typical High
$977.24
Tufts
Setting
Professional
Modifier
None (both parts)
Typical Low
$154.88
Median
$309.03
Typical High
$562.34
U of Utah Health Plan
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$302.00
Typical High
$616.60
UPMC Health Plan
Setting
Facility
Modifier
None
Typical Low
$302.00
Median
$1,000.00
Typical High
$4,265.80
UPMC Health Plan
Setting
Professional
Modifier
None (both parts)
Typical Low
$302.00
Median
$398.11
Typical High
$398.11
UPMC Health Plan
Setting
Professional
Modifier
26 · Professional part
Typical Low
$85.11
Median
$91.20
Typical High
$91.20
UPMC Health Plan
Setting
Professional
Modifier
TC · Technical part
Typical Low
$218.78
Median
$309.03
Typical High
$309.03
United
Setting
Facility
Modifier
None
Typical Low
$457.09
Median
$870.96
Typical High
$1,513.56
United
Setting
Professional
Modifier
None (both parts)
Typical Low
$257.04
Median
$338.84
Typical High
$676.08
United
Setting
Professional
Modifier
26 · Professional part
Typical Low
$70.79
Median
$93.33
Typical High
$186.21
United
Setting
Professional
Modifier
TC · Technical part
Typical Low
$186.21
Median
$245.47
Typical High
$501.19
Univera
Setting
Facility
Modifier
None
Typical Low
$109.65
Median
$109.65
Typical High
$660.69
Univera
Setting
Facility
Modifier
TC · Technical part
Typical Low
$66.07
Median
$66.07
Typical High
$489.78
Univera
Setting
Professional
Modifier
None (both parts)
Typical Low
$263.03
Median
$288.40
Typical High
$436.52
Univera
Setting
Professional
Modifier
26 · Professional part
Typical Low
$66.07
Median
$81.28
Typical High
$131.83
Univera
Setting
Professional
Modifier
TC · Technical part
Typical Low
$194.98
Median
$204.17
Typical High
$309.03
University Health Alliance
Setting
Professional
Modifier
None (both parts)
Typical Low
$549.54
Median
$602.56
Typical High
$741.31
University Health Alliance
Setting
Professional
Modifier
26 · Professional part
Typical Low
$134.90
Median
$147.91
Typical High
$181.97
University Health Alliance
Setting
Professional
Modifier
TC · Technical part
Typical Low
$407.38
Median
$446.68
Typical High
$575.44
Well Sense
Setting
Facility
Modifier
None
Typical Low
$251.19
Median
$346.74
Typical High
$489.78
Well Sense
Setting
Facility
Modifier
26 · Professional part
Typical Low
$64.57
Median
$79.43
Typical High
$131.83
Well Sense
Setting
Facility
Modifier
TC · Technical part
Typical Low
$186.21
Median
$229.09
Typical High
$380.19
Well Sense
Setting
Professional
Modifier
None (both parts)
Typical Low
$288.40
Median
$288.40
Typical High
$346.74
Wellmark
Setting
Professional
Modifier
None (both parts)
Typical Low
$588.84
Median
$660.69
Typical High
$676.08
Wellmark
Setting
Professional
Modifier
26 · Professional part
Typical Low
$162.18
Median
$186.21
Typical High
$186.21
Wellmark
Setting
Professional
Modifier
TC · Technical part
Typical Low
$426.58
Median
$478.63
Typical High
$489.78
Wellpoint
Setting
Professional
Modifier
None (both parts)
Typical Low
$223.87
Median
$302.00
Typical High
$309.03
Wellpoint
Setting
Professional
Modifier
26 · Professional part
Typical Low
$63.10
Median
$83.18
Typical High
$87.10
Wellpoint
Setting
Professional
Modifier
TC · Technical part
Typical Low
$162.18
Median
$218.78
Typical High
$229.09
31 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Facility
Modifier
CT · Older CT scanner
Typical Low
$234.42
Median
$398.11
Typical High
$1,202.26
Aetna
Setting
Facility
Modifier
FX · Film X-ray
Typical Low
$218.78
Median
$380.19
Typical High
$1,148.15
Aetna
Setting
Professional
Modifier
CT · Older CT scanner
Typical Low
$208.93
Median
$275.42
Typical High
$323.59
Aetna
Setting
Professional
Modifier
FX · Film X-ray
Typical Low
$194.98
Median
$257.04
Typical High
$309.03
Ambetter
Setting
Professional
Modifier
59 · Distinct service
Typical Low
$199.53
Median
$234.42
Typical High
$234.42
Ambetter
Setting
Professional
Modifier
Q6 · Substitute physician, paid per time
Typical Low
$223.87
Median
$234.42
Typical High
$338.84
Ambetter
Setting
Professional
Modifier
XU · Unusual separate service
Typical Low
$213.80
Median
$213.80
Typical High
$257.04
BCBS Alabama
Setting
Professional
Modifier
21 + 22 · Increased work + 24 · Unrelated visit after surgery + 31 + 55 · Aftercare only + 99 · Multiple modifiers
Typical Low
$100.00
Median
$147.91
Typical High
$245.47
BCBS Idaho
Setting
Professional
Modifier
78 · Unplanned return to OR
Typical Low
$338.84
Median
$407.38
Typical High
$489.78
BCBS Massachusetts
Setting
Facility
Modifier
52 · Reduced service
Typical Low
$309.03
Median
$537.03
Typical High
$851.14
BCBS Massachusetts
Setting
Facility
Modifier
CT · Older CT scanner
Typical Low
$524.81
Median
$912.01
Typical High
$1,445.44
BCBS Massachusetts
Setting
Professional
Modifier
CT · Older CT scanner
Typical Low
$79.43
Median
$104.71
Typical High
$177.83
BCBS North Dakota
Setting
Professional
Modifier
22 · Increased work
Typical Low
$630.96
Median
$812.83
Typical High
$954.99
BCBS North Dakota
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$104.71
Median
$138.04
Typical High
$162.18
BCBS Wyoming
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$549.54
Median
$851.14
Typical High
$851.14
BCBS Wyoming
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$158.49
Median
$245.47
Typical High
$245.47
Emblem Health
Setting
Professional
Modifier
GL · Free upgrade
Typical Low
$251.19
Median
$302.00
Typical High
$724.44
Excellus BCBS
Setting
Professional
Modifier
FY · Cassette-based X-ray
Typical Low
$229.09
Median
$323.59
Typical High
$501.19
Health Alliance Plan
Setting
Facility
Modifier
MG · Imaging: no guideline applies
Typical Low
$416.87
Median
$2,290.87
Typical High
$2,818.38
Health Alliance Plan
Setting
Professional
Modifier
X5 · Ordered service only
Typical Low
$83.18
Median
$85.11
Typical High
$87.10
Highmark BCBS
Setting
Facility
Modifier
PN · Off-campus dept, non-excepted
Typical Low
$131.83
Median
$354.81
Typical High
$1,862.09
Martin's Point
Setting
Facility
Modifier
CT · Older CT scanner
Typical Low
$181.97
Median
$275.42
Typical High
$870.96
Martin's Point
Setting
Professional
Modifier
CT · Older CT scanner
Typical Low
$251.19
Median
$288.40
Typical High
$316.23
Martin's Point
Setting
Professional
Modifier
FX · Film X-ray
Typical Low
$234.42
Median
$269.15
Typical High
$295.12
Medcost
Setting
Professional
Modifier
27 · Multiple hospital visits
Typical Low
$354.81
Median
$446.68
Typical High
$446.68
Medcost
Setting
Professional
Modifier
51 · Multiple procedures
Typical Low
$223.87
Median
$245.47
Typical High
$446.68
Moda Health
Setting
Facility
Modifier
CT · Older CT scanner
Typical Low
$213.80
Median
$338.84
Typical High
$1,318.26
Moda Health
Setting
Facility
Modifier
FX · Film X-ray
Typical Low
$199.53
Median
$323.59
Typical High
$1,230.27
Moda Health
Setting
Facility
Modifier
MH · Imaging: guideline use unknown
Typical Low
$912.01
Median
$1,174.90
Typical High
$1,995.26
Moda Health
Setting
Professional
Modifier
X5 · Ordered service only
Typical Low
$17.78
Median
$87.10
Typical High
$91.20
Univera
Setting
Professional
Modifier
FY · Cassette-based X-ray
Typical Low
$229.09
Median
$295.12
Typical High
$478.63

What it costs in each state

The same service costs 15.8 times more in Vermont than in Utah. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Touch or drag across the chart to see any state's rate.

VT $3,162UT $200

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.