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California rates for HCPCS 72196

Mri Pelvis W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$140.00 / $140.00 / $502.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.24 / $475.00 / $1,800.24
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.00 / $140.00 / $357.29
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$192.88 / $335.00 / $783.89
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.98 / $289.98 / $289.98
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$61.52 / $61.52 / $61.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.49 / $633.38 / $1,131.83
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.40 / $107.48 / $218.48
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$261.66 / $525.46 / $965.71
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$341.37 / $520.08 / $1,202.73
Blue Shield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.18 / $104.63 / $253.93
Blue Shield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$271.17 / $415.45 / $955.78
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
$266.14 / $573.49 / $1,101.89
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.05 / $100.43 / $228.43
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$193.72 / $432.92 / $899.46
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.02 / $353.01 / $476.56
Contra Costa Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.01 / $90.49 / $122.16
Contra Costa Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$212.02 / $262.52 / $354.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.72 / $367.29 / $664.29
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.44 / $117.64 / $400.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$223.84 / $307.92 / $572.29
Lucent Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$746.48 / $746.48 / $764.32
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,389.77 / $3,491.47 / $3,491.47
Lucent Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$657.14 / $657.14 / $657.14
Lucent Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$2,953.83 / $3,042.45 / $3,042.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $294.02
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$93.41 / $93.41 / $93.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.55 / $600.85 / $966.97
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.48 / $98.36 / $217.50
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$193.72 / $445.69 / $886.00
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,035.89 / $1,035.89 / $1,035.89
Sutter Health Plus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$282.04 / $282.04 / $282.04
Sutter Health Plus
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$753.84 / $753.84 / $753.84
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.50 / $392.56 / $1,370.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.11 / $454.48 / $1,063.08
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.92 / $88.78 / $209.66
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$192.64 / $356.47 / $723.94