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Maryland rates for HCPCS 75572

Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$70.56 / $70.56 / $70.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.46 / $275.00 / $793.27
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.56 / $84.43 / $214.50
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$136.90 / $191.62 / $366.89
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.98 / $329.98 / $419.07
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$90.10 / $90.10 / $115.33
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$215.89 / $239.88 / $304.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.22 / $332.24 / $636.03
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.68 / $97.10 / $192.29
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$130.79 / $227.84 / $420.06
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.46 / $308.89 / $475.26
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.20 / $95.93 / $134.15
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$157.13 / $202.71 / $341.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.76 / $283.76 / $481.08
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.48 / $86.75 / $152.38
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$120.16 / $201.77 / $413.96
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.57 / $259.87 / $337.83
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.86 / $86.38 / $112.29
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$125.71 / $173.48 / $221.77