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Nebraska 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
$55.50 / $298.12 / $502.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.97 / $285.95 / $1,361.63
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$55.50 / $129.62 / $142.96
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$164.47 / $345.83 / $438.26
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$106.02 / $106.02 / $106.02
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$325.48 / $325.48 / $325.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.92 / $433.88 / $455.33
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$101.12 / $108.08 / $114.88
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$304.80 / $325.80 / $340.44
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$318.95 / $318.95 / $318.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.75 / $536.50 / $749.52
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$73.12 / $126.93 / $163.87
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$225.64 / $406.85 / $586.00
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$537.20 / $537.20 / $537.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.51 / $524.05 / $2,195.67
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.08 / $117.66 / $439.20
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$252.30 / $406.40 / $1,890.23
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$186.81 / $192.25 / $318.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.60 / $546.29 / $733.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.36 / $200.14 / $413.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.51 / $494.27 / $633.67
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.08 / $114.44 / $144.38
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$252.30 / $395.07 / $471.81