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Michigan rates for HCPCS 72191

Ct Angiography Pelvis W/Contrast/Noncontrast

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$109.36 / $109.36 / $137.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.10 / $370.00 / $618.64
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$78.34 / $91.56 / $128.65
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$170.12 / $285.00 / $508.96
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$71.45 / $71.45 / $71.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.13 / $385.99 / $553.96
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$134.75 / $134.75 / $134.75
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$96.97 / $96.97 / $96.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.77 / $474.29 / $842.84
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.11 / $102.18 / $209.72
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$199.61 / $352.65 / $672.83
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$71.48 / $71.48 / $137.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.66 / $360.13 / $511.60
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$71.48 / $92.92 / $164.04
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$194.68 / $288.66 / $427.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.51 / $169.31 / $297.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.02 / $450.44 / $608.61
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$80.89 / $93.71 / $149.56
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$216.02 / $303.10 / $492.31