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Nebraska rates for HCPCS 72196

Mri Pelvis W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$79.03 / $425.66 / $717.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.99 / $453.82 / $1,753.31
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.03 / $174.95 / $202.47
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$183.96 / $183.96 / $1,310.07
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$84.15 / $84.15 / $84.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.27 / $510.16 / $544.38
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$143.72 / $153.62 / $163.59
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$333.54 / $356.51 / $380.80
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$453.36 / $453.36 / $453.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.39 / $608.77 / $924.95
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.34 / $180.56 / $231.74
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$300.39 / $428.22 / $688.01
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
$434.84 / $672.74 / $3,389.77
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$99.54 / $167.54 / $657.14
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$308.33 / $513.90 / $2,953.83
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$264.81 / $272.52 / $453.36
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$516.87 / $702.79 / $1,053.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.40 / $250.27 / $446.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.84 / $637.76 / $1,090.81
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$99.54 / $165.96 / $210.83
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$246.67 / $474.74 / $585.34