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Arizona rates for HCPCS 72196

Mri Pelvis W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$114.96 / $278.10 / $347.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.63 / $473.26 / $671.22
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.72 / $128.00 / $193.17
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$187.50 / $335.00 / $370.28
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.92 / $202.92 / $202.92
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$61.86 / $61.86 / $62.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.04 / $309.76 / $387.20
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$71.02 / $81.16 / $101.45
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$200.03 / $228.60 / $285.75
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$93.41 / $93.41 / $93.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.06 / $540.54 / $844.26
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$60.27 / $102.46 / $176.15
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$163.57 / $381.48 / $715.37
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$764.32 / $764.32 / $764.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.11 / $538.76 / $3,389.77
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.54 / $83.48 / $657.14
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$192.64 / $455.25 / $2,953.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.11 / $455.10 / $678.15
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.54 / $75.47 / $162.80
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$192.64 / $336.90 / $521.78