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Wisconsin rates for HCPCS 72193

Computed tomography, pelvis; with contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$107.15 / $114.82 / $181.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $302.00 / $616.60
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.48 / $97.72 / $208.93
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$162.18 / $218.78 / $416.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $363.08 / $1,258.93
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.70 / $83.18 / $309.03
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$173.78 / $275.42 / $977.24
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $208.93 / $295.12
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$144.54 / $169.82 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $549.54 / $954.99
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.12 / $114.82 / $223.87
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$173.78 / $371.54 / $741.31
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $512.86 / $691.83
DeanCare
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.00 / $120.23 / $162.18
DeanCare
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$323.59 / $389.05 / $524.81
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$512.86 / $512.86 / $512.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $537.03 / $1,819.70
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$58.88 / $123.03 / $363.08
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$204.17 / $416.87 / $1,513.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $295.12
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $575.44 / $1,122.02
Quartz
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$128.82 / $501.19 / $501.19
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $1,148.15 / $1,862.09
Quartz
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$69.18 / $288.40 / $363.08
Quartz
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$239.88 / $870.96 / $1,584.89
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,148.15 / $1,584.89
Security Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$186.21 / $194.98 / $263.03
Security Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$537.03 / $630.96 / $870.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $398.11 / $851.14
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$58.88 / $91.20 / $208.93
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$186.21 / $302.00 / $676.08