MRI pelvis without contrast dye at Holy Name

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

MRI PELVIS- WO CONTR

Teaneck, NJ

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Pricing by billing methodology

Price type

How this price compares nationally

Holy Name’s median price of $732 is 24% above the median hospital's median price ($591), higher than 55% of the 2,586 hospitals reporting CPT 72195. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting CPT 72195 at Holy Name

Negotiated rates from the hospital’s own file: 9 payers, 25 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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1	Aetna medicare prime facility · percent of total billed charges · outpatientfrom % of charges	$169	$169	—	—	—	$169 – $169
2	Aetna golden medicare facility · percent of total billed charges · outpatientfrom % of charges	$206	$206	—	—	—	$206 – $206
3	Aetna medicare prime facility · fee schedule · outpatient	$256	$256	—	—	—	$256 – $256
4	UnitedHealthcare medicaid facility · percent of total billed charges · outpatientfrom % of charges	$341	$282	$94	33%	—	$149 – $355
5	Aetna golden medicare facility · fee schedule · outpatient	$285	$285	—	—	—	$285 – $285
6	Clover clover facility · fee schedule · outpatient	$285	$285	—	—	—	$285 – $285
7	UnitedHealthcare medicare facility · fee schedule · outpatient	$285	$285	—	—	—	$285 – $285
8	WellCare medicare facility · fee schedule · outpatient	$288	$288	—	—	—	$288 – $288
9	Aetna better health mcd/chip facility · percent of total billed charges · outpatientfrom % of charges	$358	$296	$99	33%	—	$156 – $372
10	Aetna whole health facility · percent of total billed charges · outpatientfrom % of charges	$300	$300	—	—	—	$300 – $300
11	Aetna qualified health plans facility · percent of total billed charges · outpatientfrom % of charges	$410	$338	$113	33%	—	$179 – $426
12	Ambetter ambetter facility · percent of total billed charges · outpatientfrom % of charges	$534	$441	$147	33%	—	$233 – $555
13	Cigna hmo/pos facility · percent of total billed charges · outpatientfrom % of charges	$466	$466	—	—	—	$466 – $466
14	Aetna whole health facility · fee schedule · outpatient	$516	$516	—	—	—	$516 – $516
15	Aetna hmo/pos facility · percent of total billed charges · outpatientfrom % of charges	$720	$594	$198	33%	—	$314 – $748
16	UnitedHealthcare uhc facility · other · outpatient	$810	$810	—	—	—	$810 – $810
17	Cigna hmo/pos facility · fee schedule · outpatient	$812	$812	—	—	—	$812 – $812
18	First Health first health facility · percent of total billed charges · outpatientfrom % of charges	$1.0k	$843	$281	33%	—	$446 – $1.1k
19	Aetna worker's comp facility · percent of total billed charges · outpatientfrom % of charges	$1.3k	$1.1k	$359	33%	—	$569 – $1.4k
20	MultiPlan multiplan facility · percent of total billed charges · outpatientfrom % of charges	$1.4k	$1.1k	$382	33%	—	$606 – $1.4k
21	MultiPlan worker's comp facility · percent of total billed charges · outpatientfrom % of charges	$1.8k	$1.5k	$500	33%	—	$792 – $1.9k
22	MultiPlan auto accident medical facility · percent of total billed charges · outpatientfrom % of charges	$1.9k	$1.6k	$530	33%	—	$839 – $2.0k
23	Blue Cross Blue Shield indemnity facility · percent of total billed charges · outpatientfrom % of charges	$2.0k	$1.6k	$546	33%	—	$864 – $2.1k
24	Blue Cross Blue Shield managed facility · percent of total billed charges · outpatientfrom % of charges	$2.0k	$1.6k	$546	33%	—	$864 – $2.1k
25	Blue Cross Blue Shield ppo facility · percent of total billed charges · outpatientfrom % of charges	$2.0k	$1.6k	$546	33%	—	$864 – $2.1k

Last updated: Nov 10, 2025

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