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Maryland rates for HCPCS 72194

Ct Pelvis W/O & W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$49.58 / $49.58 / $49.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.73 / $285.58 / $1,091.03
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.58 / $57.48 / $154.79
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$159.15 / $214.85 / $915.42
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.39 / $343.00 / $392.05
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$58.28 / $63.79 / $74.30
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$260.52 / $279.20 / $319.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.37 / $406.47 / $709.66
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.64 / $68.06 / $130.37
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$180.92 / $330.92 / $558.46
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.94 / $340.48 / $555.16
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.94 / $69.25 / $102.30
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$206.23 / $266.04 / $436.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.59 / $301.75 / $528.33
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.47 / $65.78 / $119.77
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$170.17 / $246.77 / $455.09
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.71 / $272.61 / $354.39
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.17 / $60.57 / $78.73
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$153.54 / $212.05 / $271.08