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Missouri rates for HCPCS 74177

Computed tomography, abdomen and pelvis; with contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$96.43 / $112.00 / $180.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.68 / $366.71 / $1,477.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$80.36 / $104.71 / $317.79
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$225.84 / $270.86 / $1,155.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.27 / $224.49 / $253.53
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.97 / $88.19 / $123.20
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$154.78 / $154.78 / $337.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.11 / $380.39 / $644.02
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$90.32 / $116.24 / $182.50
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$198.79 / $264.02 / $458.72
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$98.40 / $98.40 / $98.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.36 / $442.33 / $639.26
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.79 / $123.20 / $215.07
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$188.54 / $319.62 / $481.45
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$630.16 / $805.76 / $805.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.07 / $418.35 / $2,077.84
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$93.47 / $123.48 / $547.02
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$226.97 / $304.81 / $2,614.00
Qualchoice
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$141.68 / $156.99 / $156.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.06 / $384.99 / $734.85
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.88 / $110.89 / $202.77
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$226.97 / $284.69 / $517.29