go back

Washington rates for HCPCS 72197

Mri Pelvis W/O & W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$117.45 / $192.43 / $390.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.88 / $522.50 / $1,398.33
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.00 / $145.65 / $331.05
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$282.87 / $354.60 / $748.87
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.35 / $643.04 / $1,014.56
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.08 / $179.37 / $201.11
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$264.79 / $519.87 / $519.87
Asuris Northwest Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$714.15 / $973.04 / $973.04
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.42 / $838.52 / $6,025.38
Asuris Northwest Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$142.76 / $248.62 / $891.52
Asuris Northwest Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$350.66 / $633.03 / $5,457.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.68 / $751.15 / $1,362.63
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.98 / $189.85 / $327.32
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$272.44 / $584.78 / $1,050.71
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$115.24 / $235.03 / $1,102.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.02 / $930.60 / $1,832.45
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.30 / $220.46 / $285.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$383.65 / $691.83 / $1,582.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.21 / $300.95 / $745.03
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$169.40 / $204.76 / $216.41
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.93 / $345.93 / $345.93
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$148.94 / $191.40 / $221.77
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$470.33 / $679.06 / $1,079.96
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$139.97 / $139.97 / $140.76
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$544.88 / $818.11 / $1,043.64
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$159.81 / $242.21 / $293.22
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$385.08 / $588.41 / $753.50
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$714.15 / $714.15 / $1,538.06
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.42 / $718.99 / $1,076.82
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$142.76 / $213.14 / $287.87
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$350.66 / $507.24 / $780.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.13 / $573.44 / $1,152.78
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$95.10 / $123.35 / $305.36
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$242.03 / $497.06 / $893.68
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.72 / $389.72 / $389.72
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$108.71 / $108.71 / $108.71
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$281.01 / $281.01 / $281.01