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Virginia 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
$112.59 / $155.65 / $211.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.00 / $475.00 / $680.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.97 / $126.00 / $193.79
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$118.33 / $200.00 / $262.50
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$179.15 / $335.00 / $483.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.27 / $277.85 / $459.36
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$62.70 / $78.81 / $122.65
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$153.96 / $196.89 / $330.00
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.65 / $412.56 / $1,570.27
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.73 / $79.51 / $99.39
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$318.02 / $333.05 / $516.23
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
$215.41 / $499.80 / $815.93
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.33 / $91.45 / $164.97
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$157.37 / $403.80 / $669.95
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.97 / $266.36 / $327.20
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$62.05 / $76.65 / $92.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$159.91 / $191.90 / $235.18
Medcost
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$104.24 / $120.00 / $215.35
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.00 / $421.00 / $784.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.41 / $431.85 / $728.64
Sentara
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$73.75 / $97.83 / $154.91
Sentara
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$193.38 / $359.03 / $524.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.42 / $383.82 / $788.26
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.75 / $89.37 / $148.19
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$154.72 / $294.32 / $654.16