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Alaska rates for HCPCS 72197

Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$325.79 / $675.21 / $798.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.00 / $522.50 / $1,874.79
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$140.00 / $154.00 / $638.67
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$335.00 / $368.50 / $1,236.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$513.79 / $1,125.00 / $1,271.30
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$158.44 / $337.50 / $357.94
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$355.35 / $787.50 / $913.37
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$828.08 / $993.69 / $2,176.41
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$251.50 / $307.49 / $755.92
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$535.01 / $691.89 / $1,420.49
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,280.00 / $1,484.80 / $2,469.89
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$388.75 / $419.90 / $704.25
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$891.25 / $1,135.40 / $1,788.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.74 / $1,298.75 / $2,456.27
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$337.50 / $465.00 / $692.85
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$833.00 / $1,183.50 / $1,788.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$943.88 / $1,415.82 / $2,005.75
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$154.00 / $461.76 / $654.16
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$636.04 / $954.06 / $1,457.05