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Alaska rates for HCPCS 72192

Computed tomography, pelvis; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$161.56 / $287.35 / $345.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.65 / $271.06 / $580.85
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.78 / $58.14 / $229.88
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$173.87 / $216.49 / $311.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.08 / $475.46 / $700.00
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.51 / $165.86 / $210.00
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$125.56 / $311.87 / $490.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.50 / $396.37 / $872.36
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$123.73 / $148.47 / $374.83
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$189.11 / $244.53 / $497.53
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$506.25 / $552.15 / $914.12
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$191.25 / $206.55 / $344.19
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$315.00 / $345.60 / $569.92
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.49 / $511.25 / $867.30
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$154.00 / $231.00 / $344.19
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$310.80 / $382.50 / $569.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.12 / $537.17 / $855.91
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$132.33 / $152.68 / $339.54
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$205.43 / $309.93 / $491.00