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Idaho 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
$150.33 / $393.94 / $397.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.00 / $522.50 / $1,079.92
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.34 / $154.00 / $348.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$335.00 / $368.50 / $748.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.41 / $331.28 / $976.42
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.03 / $97.27 / $197.59
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$209.38 / $234.01 / $709.55
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,418.56 / $2,418.56 / $3,212.57
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$857.15 / $857.15 / $858.90
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,559.66 / $1,559.66 / $2,355.42
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.53 / $629.34 / $827.10
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$165.99 / $191.14 / $223.33
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$380.54 / $438.20 / $512.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $187.49 / $533.98
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$714.15 / $714.15 / $714.15
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$572.28 / $711.72 / $827.10
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$179.33 / $210.98 / $254.32
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$425.63 / $500.74 / $572.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.13 / $573.44 / $1,209.03
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$93.17 / $117.80 / $210.80
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$242.03 / $455.58 / $1,006.73