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New Hampshire 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
$122.48 / $318.39 / $318.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.50 / $475.00 / $600.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$111.15 / $127.50 / $140.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$259.35 / $335.00 / $480.00
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$62.89 / $62.89 / $62.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $564.63 / $818.71
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$78.59 / $167.94 / $237.50
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$185.67 / $396.69 / $575.20
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$108.44 / $108.44 / $108.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.67 / $651.55 / $1,301.80
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$99.24 / $167.71 / $241.90
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$259.36 / $465.15 / $1,107.56
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.54 / $537.66 / $996.60
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.98 / $150.78 / $296.39
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$212.55 / $377.74 / $700.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$334.64 / $503.39 / $1,133.72
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.25 / $115.42 / $235.33
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$283.33 / $342.37 / $898.39
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.99 / $531.59 / $781.43
Well Sense
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.17 / $79.31 / $107.30
Well Sense
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$373.63 / $447.85 / $605.87