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Nebraska 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
$66.59 / $222.99 / $604.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.95 / $615.30 / $1,542.43
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.59 / $155.15 / $282.00
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$111.98 / $111.98 / $771.22
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$157.35 / $335.00 / $1,098.88
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$506.79 / $506.79 / $506.79
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$71.66 / $122.17 / $155.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.51 / $435.60 / $463.57
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$122.15 / $130.56 / $137.02
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$285.38 / $305.04 / $325.70
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$385.32 / $385.32 / $385.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.28 / $519.51 / $785.68
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.85 / $152.91 / $195.86
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$276.76 / $366.60 / $628.25
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
$372.35 / $603.45 / $3,507.01
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.54 / $141.19 / $571.29
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$265.52 / $442.55 / $2,477.29
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$228.12 / $234.77 / $385.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.36 / $602.19 / $884.61
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.05 / $212.47 / $379.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.70 / $573.29 / $885.39
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.54 / $138.86 / $178.03
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$212.42 / $408.83 / $511.40