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New Hampshire rates for HCPCS 72141

Mri Spinal Canal Cervical W/O Contrast Matrl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$105.35 / $127.50 / $292.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.26 / $425.00 / $1,320.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$97.79 / $127.50 / $292.61
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$156.63 / $200.00 / $300.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$215.47 / $297.50 / $931.29
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.23 / $153.57 / $455.33
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.80 / $56.52 / $223.45
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$99.20 / $99.20 / $99.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.61 / $400.84 / $581.21
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$67.59 / $144.44 / $204.26
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$120.01 / $256.39 / $370.41
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$108.44 / $108.44 / $108.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.14 / $447.18 / $1,066.81
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$86.58 / $143.55 / $209.97
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$167.40 / $295.95 / $891.95
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.77 / $380.87 / $707.47
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.39 / $137.54 / $254.93
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$137.38 / $244.15 / $452.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.81 / $351.24 / $685.17
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$76.15 / $98.39 / $198.35
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$180.48 / $216.54 / $509.45
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.11 / $355.20 / $498.33
Well Sense
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.16 / $70.88 / $92.27
Well Sense
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$112.13 / $134.56 / $151.38
Well Sense
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$204.47 / $247.14 / $390.07