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Arizona rates for HCPCS 72195

Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$97.49 / $157.50 / $281.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.45 / $475.00 / $963.49
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$73.05 / $140.00 / $264.06
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$122.06 / $187.50 / $237.50
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$188.15 / $335.00 / $441.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.80 / $202.12 / $645.28
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.33 / $92.22 / $122.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.27 / $263.17 / $328.96
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$60.19 / $68.79 / $85.99
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$170.08 / $194.38 / $242.97
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$79.45 / $79.45 / $79.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $464.00 / $760.47
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.64 / $86.30 / $148.58
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$141.02 / $350.62 / $629.76
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$650.32 / $650.32 / $650.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.76 / $478.64 / $3,507.01
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$59.27 / $70.95 / $571.29
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$165.95 / $415.39 / $2,477.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.76 / $409.67 / $603.36
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$59.27 / $64.25 / $141.25
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$165.95 / $340.50 / $468.72