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Pennsylvania 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
$64.03 / $81.76 / $164.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.49 / $275.00 / $674.68
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.41 / $59.29 / $127.70
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$159.22 / $203.52 / $362.21
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.56 / $178.25 / $204.88
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.28 / $44.17 / $50.35
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.21 / $240.98 / $386.85
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.40 / $93.53 / $141.13
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$174.82 / $181.41 / $707.36
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$65.64 / $65.64 / $65.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.73 / $399.15 / $670.94
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.89 / $70.48 / $114.76
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$170.46 / $309.41 / $548.61
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.52 / $373.89 / $969.09
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$62.76 / $75.43 / $119.13
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$209.18 / $260.51 / $371.12
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.83 / $291.83 / $291.83
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.77 / $63.77 / $72.06
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$64.03 / $86.22 / $204.90
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.08 / $289.70 / $706.57
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.26 / $63.62 / $146.27
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$162.65 / $224.56 / $440.55
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.27 / $325.00 / $501.40
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$39.86 / $65.64 / $65.64
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.36 / $389.87 / $666.72
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.10 / $70.23 / $117.89
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$177.21 / $300.95 / $528.09
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$57.10 / $57.10 / $65.50
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.93 / $227.36 / $390.50
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$55.65 / $57.10 / $65.50
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$164.83 / $171.71 / $325.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.68 / $327.33 / $517.03
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.07 / $68.04 / $113.65
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$180.48 / $251.49 / $417.68