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Maine rates for HCPCS 72194

Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$69.56 / $69.76 / $69.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.00 / $343.39 / $433.59
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.46 / $58.91 / $87.74
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$189.09 / $290.93 / $357.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.89 / $342.48 / $526.62
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.16 / $77.84 / $118.18
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$181.38 / $252.01 / $408.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.07 / $452.86 / $690.00
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.95 / $92.60 / $129.52
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$260.27 / $381.39 / $490.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.10 / $377.98 / $681.85
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.48 / $84.82 / $153.02
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$243.61 / $293.14 / $528.83
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$69.56 / $69.56 / $69.76
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.83 / $394.90 / $590.94
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$55.32 / $69.76 / $142.13
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$206.08 / $323.64 / $434.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.81 / $371.85 / $643.35
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$61.73 / $87.12 / $153.71
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$194.57 / $281.86 / $499.42