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Pennsylvania 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
$104.71 / $190.55 / $416.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $549.54 / $2,511.89
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.33 / $186.21 / $398.11
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$245.47 / $363.08 / $1,258.93
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $269.15 / $478.63
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.18 / $147.91 / $186.21
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$151.36 / $295.12 / $354.81
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $478.63 / $1,202.26
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$114.82 / $138.04 / $263.03
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$245.47 / $338.84 / $1,096.48
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$25.70 / $120.23 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $691.83 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.62 / $131.83 / $218.78
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$239.88 / $524.81 / $1,122.02
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $467.74 / $1,584.89
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.33 / $134.90 / $165.96
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$251.19 / $316.23 / $398.11
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $549.54 / $1,047.13
Geisinger
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$91.20 / $125.89 / $223.87
Geisinger
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$234.42 / $446.68 / $870.96
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $407.38 / $851.14
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$114.82 / $125.89 / $177.83
Highmark BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$354.81 / $426.58 / $1,000.00
Independence Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,089.30
Independence Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.65 / $128.82 / $169.82
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$104.71 / $165.96 / $416.87
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $549.54 / $1,548.82
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.71 / $162.18 / $346.74
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$251.19 / $380.19 / $891.25
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $602.56 / $977.24
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$102.33 / $120.23 / $120.23
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $346.74 / $467.74
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.00 / $104.71 / $120.23
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$229.09 / $239.88 / $933.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $501.19 / $1,071.52
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.13 / $112.20 / $199.53
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$234.42 / $346.74 / $870.96