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Pennsylvania rates for HCPCS 76380

Ct Limited/Localized Follow Up Study

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$50.19 / $62.88 / $158.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.40 / $142.49 / $275.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$40.26 / $48.07 / $127.53
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$73.76 / $92.30 / $192.00
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.79 / $34.79 / $84.98
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.94 / $133.82 / $260.56
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.04 / $46.74 / $91.75
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.91 / $87.08 / $168.80
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$51.84 / $51.84 / $51.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.78 / $204.84 / $331.20
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$32.83 / $56.01 / $91.88
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$74.81 / $142.13 / $241.79
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $205.25 / $465.34
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.20 / $58.94 / $93.28
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$100.41 / $125.05 / $178.13
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.87 / $165.87 / $165.87
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.26 / $55.29 / $84.36
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$50.19 / $83.28 / $164.12
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.32 / $161.27 / $311.12
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.64 / $51.30 / $124.23
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$73.76 / $103.82 / $197.52
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.90 / $240.26 / $325.89
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$31.98 / $51.84 / $51.84
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.65 / $202.33 / $331.20
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.36 / $55.24 / $93.42
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$79.16 / $136.38 / $235.26
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$44.85 / $44.85 / $53.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.12 / $126.33 / $187.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.63 / $44.95 / $53.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$79.17 / $82.55 / $134.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.92 / $168.01 / $271.49
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.28 / $53.53 / $89.83
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$82.18 / $113.59 / $187.69