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Alaska rates for HCPCS 76100

Radiologic examination, single plane body section (eg, tomography), other than with urography

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$87.40 / $87.40 / $87.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.79 / $117.41 / $269.16
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$69.26 / $86.27 / $172.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.00 / $277.02 / $319.31
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$91.30 / $181.39 / $223.82
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.48 / $256.17 / $561.99
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$136.13 / $176.61 / $361.24
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.00 / $361.80 / $614.63
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$222.50 / $251.10 / $417.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.64 / $324.00 / $591.82
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$188.22 / $280.50 / $417.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.71 / $245.45 / $611.92
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$125.76 / $203.43 / $372.95