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Washington rates for HCPCS 72193

Computed tomography, pelvis; with contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$61.66 / $72.44 / $154.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $302.00 / $1,122.02
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.48 / $83.18 / $213.80
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$162.18 / $218.78 / $446.68
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $436.52 / $436.52
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$40.74 / $93.33 / $95.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $380.19 / $724.44
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.71 / $81.28 / $162.18
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$162.18 / $302.00 / $562.34
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$63.10 / $107.15 / $489.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $457.09 / $645.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.70 / $100.00 / $138.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$204.17 / $354.81 / $501.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $112.20
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$89.13 / $107.15 / $112.20
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $257.04
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.07 / $95.50 / $123.03
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$204.17 / $316.23 / $446.68
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$74.13 / $74.13 / $74.13
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $512.86 / $676.08
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.13 / $117.49 / $158.49
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$245.47 / $407.38 / $524.81
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$346.74 / $346.74 / $346.74
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $501.19 / $676.08
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.62 / $114.82 / $151.36
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$263.03 / $380.19 / $524.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $281.84 / $645.65
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.86 / $61.66 / $144.54
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$154.88 / $223.87 / $489.78
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $269.15 / $446.68
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.70 / $61.66 / $102.33
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$181.97 / $208.93 / $346.74