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Maryland rates for HCPCS 72197

Mri Pelvis W/O & W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$122.11 / $126.00 / $162.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.33 / $475.00 / $2,207.11
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$105.21 / $140.00 / $338.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$281.41 / $335.00 / $1,236.10
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.51 / $686.79 / $973.90
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$108.15 / $118.51 / $149.83
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$464.05 / $568.28 / $865.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.70 / $657.04 / $1,293.46
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.38 / $127.52 / $240.91
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$217.52 / $501.09 / $1,097.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.06 / $456.74 / $770.20
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$103.60 / $121.23 / $170.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$248.84 / $321.00 / $636.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.59 / $515.59 / $1,075.82
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.21 / $111.88 / $213.71
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$249.56 / $410.46 / $827.32
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.25 / $385.10 / $500.63
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$84.17 / $110.21 / $143.27
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$199.07 / $274.89 / $351.42