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Nebraska 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
$100.00 / $345.77 / $935.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.24 / $475.00 / $2,809.89
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.00 / $233.04 / $544.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$230.24 / $335.00 / $1,603.52
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.33 / $747.23 / $747.23
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.27 / $183.90 / $233.38
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$236.20 / $236.20 / $236.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.45 / $640.74 / $683.60
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$183.09 / $195.69 / $207.00
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$416.35 / $445.04 / $476.60
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$577.50 / $577.50 / $577.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.71 / $764.99 / $1,159.31
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$132.28 / $229.43 / $295.74
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$363.49 / $535.55 / $897.15
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$973.04 / $973.04 / $973.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.88 / $887.92 / $6,025.38
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$129.76 / $211.95 / $891.52
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$387.57 / $645.95 / $5,457.89
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$342.67 / $352.65 / $577.50
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$649.19 / $914.38 / $1,449.76
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.48 / $314.10 / $560.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.88 / $843.54 / $1,028.64
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$128.24 / $208.40 / $267.18
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$314.77 / $568.44 / $875.45