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Maryland rates for HCPCS 72192

Computed tomography, pelvis; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$44.67 / $53.70 / $60.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $245.47 / $724.44
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.98 / $77.62 / $190.55
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.18 / $141.25 / $338.84
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $169.82 / $218.78
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.70 / $67.61 / $85.11
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$109.65 / $123.03 / $169.82
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$83.18 / $83.18 / $83.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $223.87 / $416.87
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.81 / $60.26 / $114.82
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$74.13 / $147.91 / $295.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $158.49 / $288.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.12 / $56.23 / $77.62
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$87.10 / $102.33 / $204.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $190.55 / $354.81
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.90 / $54.95 / $97.72
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$81.28 / $120.23 / $251.19
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $162.18 / $218.78
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $58.88 / $77.62
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$87.10 / $102.33 / $141.25