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New Hampshire 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
$86.23 / $223.97 / $223.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.78 / $343.39 / $1,070.21
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.08 / $55.32 / $154.79
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$161.69 / $290.93 / $915.42
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.81 / $199.81 / $199.81
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.17 / $46.26 / $130.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.22 / $526.62 / $744.74
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$55.31 / $118.18 / $167.13
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$177.91 / $408.44 / $577.61
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$72.27 / $72.27 / $72.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.17 / $594.07 / $907.62
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.54 / $116.51 / $169.96
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$256.85 / $471.81 / $760.14
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.17 / $501.47 / $929.50
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.32 / $112.53 / $208.58
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$218.85 / $388.94 / $720.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.25 / $400.46 / $712.76
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$55.80 / $82.00 / $163.36
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$267.55 / $321.02 / $552.28
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.15 / $265.77 / $365.83
Well Sense
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.55 / $55.79 / $75.47
Well Sense
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$146.28 / $180.26 / $309.37