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Michigan rates for HCPCS 72192

Computed tomography, pelvis; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$63.10 / $66.07 / $83.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $208.93 / $645.65
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.98 / $69.18 / $186.21
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.18 / $120.23 / $288.40
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $104.71 / $109.65
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.81 / $48.98 / $85.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $199.53 / $213.80
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.28 / $81.28 / $109.65
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$134.90 / $134.90 / $181.97
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $100.00 / $173.78
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$12.59 / $58.88 / $83.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $245.47 / $478.63
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.66 / $67.61 / $151.36
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$79.43 / $158.49 / $302.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$63.10 / $66.07 / $112.20
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $204.17 / $426.58
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.86 / $66.07 / $177.83
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$91.20 / $134.90 / $281.84
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$12.59 / $58.88 / $83.18
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $218.78 / $478.63
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.90 / $57.54 / $112.20
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$69.18 / $144.54 / $275.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $173.78 / $323.59
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.86 / $57.54 / $91.20
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.18 / $109.65 / $245.47