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Montana rates for HCPCS 72141

Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$281.84 / $281.84 / $281.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $478.63 / $1,230.27
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$69.18 / $125.89 / $331.13
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$138.04 / $138.04 / $234.42
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$131.83 / $257.04 / $562.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $309.03 / $309.03
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$109.65 / $109.65 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $467.74 / $691.83
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.98 / $91.20 / $194.98
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$138.04 / $302.00 / $512.86
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $346.74 / $724.44
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$109.65 / $109.65 / $134.90
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $467.74 / $575.44
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$67.61 / $109.65 / $158.49
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$131.83 / $199.53 / $426.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $338.84 / $549.54
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.57 / $70.79 / $128.82
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$123.03 / $218.78 / $389.05