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Pennsylvania rates for HCPCS 75625

Aortography, abdominal, by serialography, radiological supervision and interpretation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$66.18 / $99.20 / $209.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.90 / $190.47 / $243.49
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.65 / $60.23 / $146.91
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$49.66 / $70.70 / $188.44
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.70 / $96.70 / $96.70
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.75 / $98.03 / $98.03
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.10 / $200.82 / $900.56
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$67.16 / $89.50 / $133.69
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$55.94 / $93.20 / $798.85
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$77.09 / $77.09 / $77.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.37 / $231.34 / $608.76
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.14 / $72.68 / $119.57
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$49.90 / $126.59 / $528.37
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.16 / $189.80 / $453.24
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.23 / $87.30 / $137.06
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$66.95 / $83.35 / $118.71
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.64 / $82.11 / $83.57
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$66.18 / $104.03 / $211.78
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.84 / $178.31 / $370.66
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.85 / $68.66 / $146.91
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$52.61 / $79.68 / $234.92
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.00 / $676.50 / $727.40
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$37.82 / $77.09 / $77.09
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.56 / $215.50 / $601.91
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.00 / $72.68 / $119.57
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$52.56 / $121.01 / $528.37
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$65.70 / $65.70 / $95.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.87 / $122.60 / $524.85
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.28 / $66.45 / $95.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$55.68 / $56.90 / $429.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.39 / $178.14 / $475.46
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.91 / $72.09 / $130.47
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$58.74 / $81.90 / $305.76