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Louisiana rates for HCPCS 72196

Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$84.52 / $110.00 / $138.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.00 / $550.00 / $600.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$67.12 / $110.00 / $145.65
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$187.50 / $393.48 / $480.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.58 / $448.18 / $759.21
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$95.66 / $125.11 / $159.44
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$273.92 / $315.70 / $599.77
Christus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.27 / $74.27 / $78.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.89 / $335.10 / $714.75
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.32 / $97.33 / $167.28
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$114.57 / $228.96 / $606.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.88 / $400.82 / $717.54
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$69.45 / $92.09 / $140.16
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$195.06 / $271.95 / $557.28