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Georgia rates for HCPCS 72197

Mri Pelvis W/O & W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$85.00 / $141.41 / $460.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.85 / $475.00 / $1,459.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.00 / $141.41 / $338.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$287.05 / $340.00 / $931.29
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.54 / $301.97 / $437.86
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.05 / $147.13 / $192.95
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$241.57 / $241.57 / $241.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.52 / $574.61 / $1,368.09
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$94.41 / $133.57 / $276.70
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$238.51 / $412.44 / $1,238.75
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.27 / $252.88 / $461.99
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$118.86 / $118.86 / $118.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.55 / $885.64 / $1,856.20
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$103.20 / $170.96 / $293.32
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$302.31 / $685.20 / $1,470.63
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.19 / $662.16 / $2,804.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$111.12 / $175.40 / $397.23
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$253.08 / $460.14 / $2,485.31
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.06 / $346.60 / $612.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.72 / $713.86 / $1,326.88
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.69 / $138.41 / $249.37
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$274.95 / $537.51 / $1,119.63