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West Virginia 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
$83.65 / $83.65 / $83.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.42 / $400.00 / $522.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.65 / $118.59 / $154.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$183.77 / $281.41 / $368.50
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.04 / $92.04 / $92.04
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$93.41 / $93.41 / $93.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.77 / $597.36 / $2,484.41
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.98 / $121.24 / $391.12
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$162.74 / $480.60 / $1,688.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.29 / $588.77 / $1,205.96
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.77 / $122.72 / $202.69
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$169.22 / $453.28 / $943.49