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Washington rates for HCPCS 72196

Mri Pelvis W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$93.05 / $183.44 / $299.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.82 / $475.00 / $859.27
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.93 / $124.32 / $239.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$229.10 / $335.00 / $598.54
Asuris Northwest Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$764.32 / $764.32 / $764.32
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.70 / $675.28 / $3,389.77
Asuris Northwest Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$112.73 / $201.64 / $671.85
Asuris Northwest Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$279.97 / $503.37 / $2,953.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.29 / $620.21 / $1,048.85
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.43 / $149.08 / $257.08
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$218.41 / $469.27 / $805.00
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$90.94 / $186.33 / $1,102.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.97 / $735.73 / $1,377.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$80.59 / $173.93 / $225.21
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$316.60 / $565.91 / $1,178.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.10 / $268.38 / $603.77
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$133.10 / $160.31 / $166.16
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$99.70 / $140.79 / $174.84
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$315.66 / $472.68 / $727.65
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$110.53 / $110.53 / $110.59
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.05 / $651.97 / $831.17
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$126.54 / $190.31 / $229.32
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$307.24 / $461.42 / $589.04
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$714.15 / $714.15 / $1,538.06
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.70 / $572.98 / $858.13
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$112.73 / $167.46 / $227.17
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$279.97 / $405.51 / $625.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.11 / $454.48 / $863.73
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.47 / $98.29 / $239.62
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$192.64 / $396.62 / $684.52
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.20 / $311.20 / $311.20
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.04 / $85.04 / $85.04
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$226.16 / $226.16 / $226.16