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New Jersey 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 / $199.53 / $363.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $316.23 / $1,122.02
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $69.18 / $162.18
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$158.49 / $223.87 / $478.63
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $165.96 / $218.78
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.67 / $53.70 / $107.15
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$39.81 / $39.81 / $39.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $389.05 / $645.65
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.69 / $74.13 / $128.82
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$169.82 / $309.03 / $537.03
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $338.84 / $891.25
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.07 / $75.86 / $891.25
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$213.80 / $257.04 / $891.25
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $245.47 / $524.81
Horizon BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.12 / $58.88 / $100.00
Horizon BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$158.49 / $190.55 / $398.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $338.84 / $575.44
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.67 / $66.07 / $114.82
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$165.96 / $269.15 / $467.74