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Idaho rates for HCPCS 72194

Ct Pelvis W/O & W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$148.76 / $148.76 / $148.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.33 / $415.33 / $494.41
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.46 / $65.06 / $128.88
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$217.28 / $345.83 / $365.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.18 / $239.38 / $505.29
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.25 / $53.92 / $109.29
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$165.94 / $185.46 / $405.93
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,072.21 / $1,072.21 / $1,190.26
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$336.79 / $336.79 / $407.36
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$664.85 / $664.85 / $853.47
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.69 / $468.31 / $617.83
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$91.26 / $105.09 / $122.79
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$315.43 / $363.22 / $424.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $103.60 / $375.17
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$346.39 / $346.39 / $346.39
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$428.52 / $532.92 / $617.83
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$98.98 / $116.45 / $141.13
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$350.00 / $416.48 / $476.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.98 / $302.05 / $630.42
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.64 / $65.73 / $122.51
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$181.91 / $256.81 / $504.01