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Maine rates for HCPCS 72192

Computed tomography, pelvis; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$70.79 / $70.79 / $70.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $194.98 / $489.78
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.86 / $61.66 / $162.18
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.18 / $120.23 / $281.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $194.98 / $446.68
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.12 / $72.44 / $169.82
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.18 / $120.23 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $269.15 / $588.84
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.48 / $75.86 / $144.54
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$93.33 / $194.98 / $380.19
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $204.17 / $398.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$60.26 / $75.86 / $141.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$100.00 / $125.89 / $251.19
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$70.79 / $70.79 / $70.79
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $223.87 / $478.63
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.12 / $72.44 / $158.49
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.50 / $141.25 / $309.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $208.93 / $398.11
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.70 / $77.62 / $141.25
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.18 / $128.82 / $263.03