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Michigan rates for HCPCS 72196

Mri Pelvis W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$106.23 / $106.23 / $111.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.55 / $345.57 / $522.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$82.78 / $106.24 / $161.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$192.88 / $239.34 / $368.50
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$62.89 / $80.34 / $162.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.96 / $386.51 / $452.54
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$129.41 / $129.41 / $129.41
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
$315.98 / $547.54 / $973.02
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$62.26 / $100.55 / $202.97
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$221.63 / $387.84 / $703.13
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$67.90 / $106.23 / $106.24
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.31 / $418.48 / $596.08
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$67.90 / $106.24 / $167.90
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$203.28 / $350.58 / $490.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.51 / $196.97 / $304.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.43 / $493.55 / $693.93
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$78.48 / $91.17 / $143.69
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$205.90 / $377.54 / $560.41