CPT stands for Current Procedural Terminology. CPT codes are a set of medical codes used by physicians, hospitals, and other healthcare providers to describe the services and procedures they provide to patients. They are essential for accurate billing and record-keeping.

How can I find the cost of a medical procedure?

Finding the exact cost of a medical procedure can be complex due to varying insurance plans, provider fees, and geographic locations. For the most accurate information tailored to your specific situation, it's best to contact your healthcare provider directly or your insurance company. For a fee schedule lookup tool based on CPT codes and your specific location, you can use services like Payerprice.

Where can I look up healthcare service prices for my specific location?

To find healthcare service prices for a specific CPT code and your location, you can utilize tools like Payerprice. Payerprice offers a fee schedule lookup tool that allows users to search for prices based on CPT codes and specific geographical areas, providing a more localized and detailed estimate than general resources.

Why is it difficult to find transparent healthcare pricing?

Healthcare pricing transparency is challenging due to several factors, including the complexity of insurance contracts, varying negotiation rates between providers and insurers, the bundling of services, and the lack of a standardized national pricing system. The final cost can also depend on your specific insurance plan's deductibles, co-pays, and out-of-pocket maximums.

What factors influence the cost of a medical service?

The cost of a medical service is influenced by numerous factors, including the type and complexity of the procedure, the healthcare provider's fees, the facility where the service is performed (e.g., hospital vs. outpatient clinic), geographic location, your insurance coverage and negotiation agreements, and whether the provider is in-network or out-of-network.

CPT 72197 Fee Schedule

Q: What factors affect fee schedules?

Factors that affect fee schedules include Medicare & Medicaid Rates (government-set reimbursement amounts), Private Insurance Rates (negotiated rates between providers and insurance companies), Geographic Location (costs may be higher in urban areas), and Provider Type (hospital providers may have different rates than private practice).

Last Verified: September 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Mri Of Pelvis, An Mri (Magnetic Resonance Imaging) Uses A Strong Magnetic Field To View And Create Images Of The Pelvis. A Contrast Agent Is Introduced To Highlight Areas. Multiple Images Are Taken.

Key Fact	Detail
Service Type	Radiology Procedures Diagnostic Radiology (Diagnostic Imaging) Procedures
Common Place of Service	11 - Office 22 - On Campus Outpatient Hospital
Common Modifiers	None 26 - Professional component TC - Technical component
Complexity Level	Moderate
Medicare Fee Schedule	View Medicare rates for 72197
Medicaid Fee Schedule	View Medicaid rates for 72197

National average reimbursement for CPT 72197 by major payers:

$447.27

$644.73

$635.75

$701.21

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CPT 72197

5 of 25 sample ratesHigher to lower in this preview

Henry Smith
OKDiagnostic Radiology PhysicianNPI 1487627238Tax ID 25-1698194
$977.21Published rate
Terry Wolf
OKDiagnostic Radiology PhysicianNPI 1669632204Tax ID 73-1046179
$544.41Published rate
Stephen Back
OKDiagnostic Radiology PhysicianNPI 1639302060Tax ID 32-0260988
$406.54Published rate
Om Imaging PLLC
OKDiagnostic Radiology PhysicianNPI 1114308079Tax ID 47-4251729
$308.77Published rate
Dean Fullingim
OKDiagnostic Radiology PhysicianNPI 1770574253Tax ID 73-6017987
$91.80Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 72197 vs. Other Diagnostic Radiology (Diagnostic Imaging) Procedures Codes

The CPT 72197 code is part of the Radiology Procedures services used for Diagnostic Radiology (Diagnostic Imaging) Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 72197 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
72195-CPT	Moderate	Mri Of The Pelvis, An Mri (Magnetic Resonance Imaging) Uses A Strong Magnetic Field To View And Create Images Of The Pelvis. A Contrast Agent May Be Introduced To Highlight An Area. Multiple Images May Be Taken.
72196-CPT	Moderate	Mri Of The Pelvis, An Mri (Magnetic Resonance Imaging) Uses A Strong Magnetic Field To View And Create Images Of The Pelvis. A Contrast Agent May Be Introduced To Highlight An Area. Multiple Images May Be Taken.
72197-CPT	Moderate	Mri Of Pelvis, An Mri (Magnetic Resonance Imaging) Uses A Strong Magnetic Field To View And Create Images Of The Pelvis. A Contrast Agent Is Introduced To Highlight Areas. Multiple Images Are Taken.
72198-CPT	Moderate	Mra Of Blood Vessels In Pelvis, An Mr (Magnetic Resonance) Angiogram Is A Detailed Image Of Blood Flow And Blood Vessels In The Pelvis. A Contrast Agent May Be Injected To Make The Area Easier To See. Multiple Images May Be Taken.

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 72197. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 72197 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

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CPT 72197 Fee Schedule

Compare published rates across providers.

Henry Smith

Terry Wolf

Stephen Back

Om Imaging PLLC

Dean Fullingim