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Oklahoma 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
$67.61 / $104.96 / $127.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.66 / $275.00 / $475.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$62.50 / $73.75 / $140.00
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$118.33 / $126.45 / $202.17
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$164.17 / $206.25 / $335.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.70 / $343.70 / $343.70
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.47 / $51.47 / $114.35
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$162.69 / $162.69 / $162.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.95 / $239.05 / $328.25
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$66.75 / $66.75 / $107.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.74 / $392.70 / $609.91
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$60.17 / $68.84 / $115.94
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$134.97 / $290.50 / $524.41
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$502.88 / $650.32 / $650.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.17 / $376.57 / $3,507.01
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$59.27 / $79.12 / $571.29
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$169.86 / $334.58 / $2,477.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.17 / $324.37 / $591.28
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$59.27 / $75.06 / $140.16
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$169.86 / $234.29 / $505.13