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Vermont rates for HCPCS 72196

Mri Pelvis W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.00 / $425.00 / $522.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$112.50 / $127.50 / $154.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$262.50 / $297.50 / $368.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.22 / $438.58 / $1,196.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.70 / $703.82 / $1,196.34
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.38 / $121.15 / $345.83
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$288.55 / $447.35 / $1,163.89
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.70 / $703.82 / $1,196.34
MVP Health Care
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$112.45 / $121.15 / $345.83
MVP Health Care
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$288.55 / $447.35 / $732.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.91 / $653.38 / $1,272.59
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$84.34 / $122.65 / $367.88
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$226.64 / $464.50 / $904.72