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Virginia 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
$118.59 / $178.20 / $297.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$347.94 / $494.18 / $904.30
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.34 / $150.25 / $249.21
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$239.54 / $344.10 / $697.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.31 / $408.33 / $675.09
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$94.65 / $117.65 / $181.73
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$224.65 / $287.27 / $488.56
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.51 / $686.79 / $3,337.22
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$117.03 / $118.51 / $148.74
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$464.05 / $568.28 / $880.83
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
$317.36 / $764.30 / $1,432.48
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$84.18 / $138.83 / $246.09
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$230.50 / $551.04 / $1,193.60
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.33 / $392.80 / $482.63
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$93.68 / $115.72 / $138.97
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$233.66 / $280.39 / $343.61
Medcost
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$161.40 / $185.00 / $334.47
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.00 / $573.00 / $1,205.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.60 / $638.12 / $1,330.13
Sentara
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$111.29 / $148.46 / $233.42
Sentara
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$282.05 / $523.65 / $828.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.74 / $547.99 / $1,416.23
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.00 / $130.90 / $201.97
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$225.70 / $429.29 / $1,133.98