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Utah 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
$100.00 / $100.00 / $100.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $371.54 / $676.08
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.79 / $93.33 / $190.55
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$158.49 / $245.47 / $512.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $478.63 / $691.83
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$72.44 / $100.00 / $181.97
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$194.98 / $354.81 / $549.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $467.74
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$323.59 / $323.59 / $323.59
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $575.44 / $812.83
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$117.49 / $154.88 / $208.93
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$323.59 / $407.38 / $616.60
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $457.09 / $660.69
Select Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.28 / $173.78 / $204.17
Select Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$169.82 / $281.84 / $446.68
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $346.74 / $602.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $380.19 / $645.65
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.13 / $79.43 / $151.36
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$194.98 / $269.15 / $467.74