go back

Alaska rates for HCPCS 72196

Mri Pelvis W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$257.55 / $257.55 / $257.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.00 / $522.50 / $1,492.05
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$140.00 / $154.00 / $504.92
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$335.00 / $368.50 / $987.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.49 / $1,011.97 / $1,055.00
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$123.13 / $282.08 / $307.50
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$286.36 / $717.50 / $738.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.68 / $792.81 / $1,731.95
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$196.50 / $241.09 / $593.73
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$430.49 / $557.01 / $1,138.17
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,021.25 / $1,196.00 / $1,970.60
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$303.75 / $328.05 / $555.75
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$717.50 / $900.20 / $1,476.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.14 / $1,035.00 / $1,953.39
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$265.26 / $369.00 / $549.80
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$717.50 / $942.00 / $1,476.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$749.36 / $896.71 / $1,554.06
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$118.23 / $364.86 / $516.89
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$506.12 / $759.18 / $1,075.50