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North Dakota 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
$73.58 / $73.58 / $117.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.66 / $389.08 / $595.78
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$67.29 / $140.00 / $191.35
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$111.98 / $134.22 / $237.50
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$164.17 / $282.22 / $368.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$456.32 / $563.13 / $590.55
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$135.44 / $167.15 / $174.71
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$320.88 / $395.98 / $415.30
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
$334.23 / $537.92 / $823.70
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$73.25 / $126.35 / $176.37
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$242.17 / $384.08 / $692.74
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
$324.37 / $681.19 / $3,507.01
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.06 / $147.16 / $571.29
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$235.44 / $518.04 / $2,477.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.77 / $603.45 / $878.51
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.06 / $135.29 / $183.31
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$234.29 / $410.88 / $866.29