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Texas 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
$71.65 / $89.48 / $185.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.92 / $341.58 / $657.24
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$72.86 / $94.32 / $308.52
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$200.27 / $247.05 / $445.97
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.29 / $284.11 / $554.01
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.65 / $115.65 / $160.03
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$120.52 / $171.77 / $349.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.84 / $251.61 / $355.00
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.00 / $394.00 / $538.34
Christus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.23 / $85.97 / $237.92
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
$235.00 / $352.19 / $643.90
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.00 / $96.73 / $177.37
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$164.50 / $256.63 / $474.02
Lucent Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$630.16 / $791.44 / $805.76
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$495.67 / $2,077.84 / $2,569.28
Lucent Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$547.02 / $547.02 / $697.13
Lucent Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$2,614.00 / $2,614.00 / $2,614.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.50 / $383.25 / $845.00
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$108.49 / $137.69 / $333.80
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$277.95 / $352.79 / $855.24
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.24 / $258.26 / $496.43
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$98.40 / $98.40 / $98.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.49 / $384.56 / $808.92
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.50 / $92.06 / $171.73
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$164.50 / $247.92 / $471.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.39 / $332.39 / $593.65
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.78 / $93.47 / $166.94
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$191.13 / $238.92 / $406.16
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.70 / $284.11 / $403.76
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$71.22 / $82.07 / $113.20
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$182.48 / $213.32 / $1,100.00