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New Jersey 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
$93.02 / $119.21 / $518.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.82 / $425.00 / $846.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.20 / $119.21 / $189.00
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$118.33 / $212.50 / $286.82
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$168.61 / $299.00 / $441.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.80 / $173.78 / $233.45
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.47 / $61.78 / $142.80
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$112.97 / $112.97 / $112.97
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.58 / $491.48 / $1,100.00
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$48.05 / $48.05 / $48.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.00 / $532.42 / $890.12
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.44 / $86.88 / $146.59
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.19 / $434.67 / $747.99
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.51 / $358.92 / $1,306.15
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.73 / $90.85 / $1,159.06
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$192.16 / $231.14 / $1,159.06
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.82 / $266.19 / $530.32
Horizon BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$58.47 / $68.79 / $103.16
Horizon BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$163.34 / $201.99 / $348.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.03 / $375.62 / $639.32
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$58.15 / $79.06 / $136.75
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$143.86 / $257.43 / $500.60