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Utah rates for HCPCS 72195

Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s)

Facilitymedian $575 · 10th–90th $129$5750%50%10th$575Professionalmedian $251 · 10th–90th $74$7410%5%10th90th$251$50.0$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$128.82 / $575.44 / $575.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $478.63 / $1,548.82
Aetna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$69.18 / $147.91 / $323.59
Aetna
Facility/Professional
Professional
Modifier
52
Typical Low / Median / Typical High
$1,513.56 / $1,513.56 / $1,513.56
Aetna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$181.97 / $338.84 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $489.78 / $741.31
Cigna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$61.66 / $85.11 / $158.49
Cigna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$154.88 / $346.74 / $630.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $501.19
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$416.87 / $416.87 / $416.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $389.05 / $794.33
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$95.50 / $112.20 / $165.96
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$234.42 / $281.84 / $630.96
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $363.08 / $776.25
Select Health
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$66.07 / $158.49 / $346.74
Select Health
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$151.36 / $204.17 / $323.59
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $263.03 / $436.52
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $363.08 / $676.08
United
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$58.88 / $63.10 / $125.89
United
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$165.96 / $263.03 / $588.84