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Utah 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
$128.82 / $128.82 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $478.63 / $1,737.80
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.28 / $123.03 / $257.04
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$194.98 / $302.00 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $537.03 / $831.76
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$69.18 / $100.00 / $177.83
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$181.97 / $398.11 / $691.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $562.34
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$676.08 / $676.08 / $676.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $524.81 / $891.25
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$114.82 / $151.36 / $199.53
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$275.42 / $371.54 / $691.83
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $426.58 / $912.01
Select Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.62 / $190.55 / $223.87
Select Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$177.83 / $239.88 / $380.19
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $309.03 / $537.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $407.38 / $660.69
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.79 / $75.86 / $147.91
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.55 / $288.40 / $537.03