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Nebraska rates for HCPCS 72193

Computed tomography, pelvis; with contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$52.85 / $176.71 / $478.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.01 / $314.75 / $1,230.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.85 / $123.50 / $217.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$164.16 / $246.13 / $452.22
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.89 / $502.89 / $502.89
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.79 / $100.94 / $122.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$401.58 / $429.25 / $439.99
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$96.81 / $103.48 / $109.40
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$304.80 / $325.80 / $333.94
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$305.33 / $305.33 / $305.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.47 / $513.25 / $677.77
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.13 / $121.17 / $156.11
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$192.50 / $384.75 / $521.66
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$514.88 / $514.88 / $514.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.61 / $475.16 / $1,817.09
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.73 / $112.05 / $364.90
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$220.19 / $363.11 / $1,526.12
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$177.91 / $183.09 / $305.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.20 / $493.96 / $653.34
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.74 / $194.05 / $374.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.61 / $447.14 / $549.04
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.73 / $110.99 / $137.28
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$220.19 / $330.29 / $423.45