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Indiana rates for HCPCS 72193

Ct Pelvis W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$55.90 / $58.32 / $85.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.89 / $254.96 / $349.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.17 / $58.32 / $104.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$157.38 / $186.85 / $255.84
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.56 / $179.65 / $311.58
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$40.27 / $41.60 / $77.70
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$240.82 / $240.82 / $240.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.70 / $308.74 / $460.10
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$60.16 / $85.90 / $108.17
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$171.08 / $221.81 / $343.80
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.37 / $180.42 / $270.04
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$62.89 / $62.89 / $62.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.28 / $373.89 / $631.73
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.17 / $72.52 / $127.26
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$170.70 / $293.79 / $510.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.77 / $294.35 / $491.54
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.31 / $62.43 / $115.29
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$158.59 / $223.89 / $376.45