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Alaska rates for HCPCS 72191

Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$265.95 / $265.95 / $265.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.27 / $477.42 / $1,017.32
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$78.34 / $91.56 / $378.42
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$309.93 / $385.85 / $638.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.99 / $973.00 / $1,140.69
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$129.00 / $276.00 / $291.89
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$335.99 / $658.87 / $849.29
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.23 / $899.55 / $1,949.31
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$204.60 / $250.67 / $616.44
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$505.68 / $654.05 / $1,332.87
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,106.25 / $1,264.95 / $2,029.38
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$316.25 / $341.55 / $567.69
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$787.80 / $926.10 / $1,461.69
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.36 / $1,123.20 / $1,849.40
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$276.00 / $381.00 / $567.69
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$681.10 / $981.00 / $1,449.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.74 / $825.73 / $2,586.00
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$123.74 / $377.85 / $881.00
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$527.09 / $733.77 / $1,705.00