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Maryland rates for HCPCS 72193

Computed tomography, pelvis; with contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$47.29 / $64.01 / $94.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.15 / $284.45 / $1,127.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.03 / $60.31 / $208.59
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$158.85 / $217.46 / $428.80
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.06 / $266.92 / $338.99
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.75 / $60.83 / $79.08
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$196.24 / $206.09 / $261.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.84 / $337.70 / $642.95
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.57 / $65.22 / $124.11
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$160.49 / $273.36 / $486.66
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.95 / $308.25 / $488.29
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.28 / $66.04 / $97.59
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$183.91 / $237.24 / $373.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.56 / $270.33 / $424.01
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.04 / $62.30 / $163.16
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$132.84 / $204.38 / $352.99
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.16 / $260.92 / $339.20
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.02 / $57.74 / $75.06
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$147.13 / $203.18 / $259.76