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Maine 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
$102.33 / $102.33 / $102.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $323.59 / $602.56
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$72.44 / $91.20 / $213.80
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$169.82 / $218.78 / $416.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $389.05 / $933.25
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.18 / $120.23 / $281.84
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$177.83 / $263.03 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $549.54 / $891.25
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.11 / $117.49 / $208.93
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$245.47 / $436.52 / $645.65
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $457.09 / $870.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.00 / $125.89 / $239.88
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$269.15 / $338.84 / $630.96
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $407.38 / $891.25
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.18 / $112.20 / $275.42
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.55 / $288.40 / $616.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $457.09 / $912.01
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.13 / $128.82 / $234.42
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$213.80 / $323.59 / $660.69