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Texas 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
$47.82 / $59.84 / $74.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.31 / $272.49 / $450.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.00 / $59.78 / $89.79
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$149.43 / $206.08 / $357.10
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.78 / $199.81 / $235.27
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.54 / $54.42 / $106.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.88 / $164.55 / $260.22
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.00 / $160.00 / $160.00
Christus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.87 / $57.50 / $167.91
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
$211.29 / $328.11 / $613.79
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.54 / $68.77 / $123.00
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$163.19 / $255.64 / $488.98
Lucent Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$417.20 / $525.76 / $537.20
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,195.67 / $2,261.56 / $2,261.56
Lucent Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$439.20 / $439.20 / $459.75
Lucent Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,890.23 / $1,946.93 / $1,946.93
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.10 / $406.69 / $610.65
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$71.90 / $91.26 / $221.24
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$248.52 / $315.43 / $764.68
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.76 / $240.00 / $452.98
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$65.64 / $65.64 / $65.64
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.51 / $366.05 / $719.53
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.08 / $67.88 / $119.10
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$163.19 / $251.90 / $485.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.31 / $314.35 / $552.90
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.28 / $62.44 / $106.41
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$176.08 / $248.89 / $428.02
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.05 / $222.54 / $316.86
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.21 / $54.42 / $75.13
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$151.84 / $177.49 / $1,100.00