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Maryland 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
$80.89 / $126.00 / $151.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.95 / $475.00 / $1,320.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$76.48 / $140.00 / $282.00
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$125.00 / $212.50 / $587.63
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$233.85 / $335.00 / $972.99
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.65 / $412.56 / $495.98
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.09 / $79.51 / $90.88
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$318.02 / $333.05 / $418.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.42 / $467.95 / $787.22
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.85 / $82.53 / $161.06
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$149.08 / $335.04 / $632.26
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.93 / $309.51 / $522.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$68.62 / $83.54 / $113.34
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$170.31 / $219.70 / $409.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.83 / $321.19 / $732.15
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.42 / $75.06 / $169.55
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$166.90 / $253.81 / $618.19
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.94 / $261.14 / $339.48
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$55.70 / $73.00 / $94.90
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$136.25 / $188.14 / $240.52