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Washington 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
$93.33 / $128.82 / $208.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $309.03 / $1,122.02
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $64.57 / $173.78
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$162.18 / $223.87 / $467.74
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $165.96 / $165.96
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$91.20 / $91.20 / $91.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $446.68 / $851.14
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.98 / $85.11 / $169.82
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.55 / $380.19 / $676.08
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$66.07 / $112.20 / $489.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $524.81 / $707.95
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.23 / $107.15 / $144.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$234.42 / $407.38 / $575.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $125.89
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$93.33 / $112.20 / $117.49
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $165.96 / $257.04
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$69.18 / $91.20 / $123.03
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$251.19 / $371.54 / $537.03
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$77.62 / $77.62 / $77.62
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $588.84 / $758.58
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.62 / $123.03 / $165.96
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$275.42 / $457.09 / $588.84
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$346.74 / $346.74 / $346.74
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $549.54 / $741.31
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.43 / $123.03 / $158.49
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$288.40 / $436.52 / $588.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $331.13 / $724.44
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.12 / $64.57 / $154.88
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$177.83 / $269.15 / $562.34
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $281.84 / $467.74
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.23 / $66.07 / $107.15
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.55 / $218.78 / $354.81