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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
$69.18 / $69.18 / $70.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $288.40 / $630.96
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $69.18 / $177.83
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$165.96 / $213.80 / $446.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $338.84 / $794.33
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.23 / $81.28 / $190.55
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$177.83 / $257.04 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $457.09 / $741.31
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.54 / $83.18 / $162.18
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$218.78 / $363.08 / $575.44
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $380.19 / $724.44
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$67.61 / $85.11 / $162.18
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$234.42 / $295.12 / $562.34
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$69.18 / $69.18 / $70.79
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $380.19 / $758.58
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.54 / $81.28 / $186.21
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.55 / $288.40 / $562.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $380.19 / $724.44
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$60.26 / $87.10 / $158.49
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$194.98 / $295.12 / $549.54