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Illinois rates for HCPCS 72193

Computed tomography, pelvis; with contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$57.54 / $95.50 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $309.03 / $954.99
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.48 / $91.20 / $208.93
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$162.18 / $218.78 / $436.52
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$40.74 / $51.29 / $79.43
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$218.78 / $218.78 / $218.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $223.87 / $467.74
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$72.44 / $72.44 / $72.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $331.13 / $524.81
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $75.86 / $112.20
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$162.18 / $251.19 / $407.38
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $467.74 / $1,445.44
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.57 / $109.65 / $407.38
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$199.53 / $346.74 / $1,148.15
Hally Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $275.42 / $302.00
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.07 / $67.61 / $70.79
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$204.17 / $213.80 / $229.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $316.23 / $478.63
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.48 / $69.18 / $107.15
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$169.82 / $239.88 / $389.05