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Idaho rates for HCPCS 72142

Mri Spinal Canal Cervical W/Contrast Matrl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$219.66 / $219.66 / $219.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.24 / $494.18 / $877.78
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$94.10 / $140.00 / $269.35
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$275.50 / $348.53 / $608.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.35 / $267.51 / $644.04
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.81 / $79.14 / $160.79
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$168.54 / $188.37 / $536.92
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,688.00 / $1,688.00 / $1,873.83
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$617.16 / $617.16 / $746.48
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$941.52 / $941.52 / $1,256.66
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.25 / $515.01 / $673.71
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$135.56 / $156.10 / $182.40
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$311.69 / $358.91 / $419.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $137.29 / $486.60
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$714.15 / $714.15 / $714.15
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.91 / $582.25 / $673.71
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$146.72 / $172.62 / $207.78
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$348.19 / $409.63 / $465.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.41 / $467.83 / $1,007.51
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.92 / $96.25 / $172.73
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$194.49 / $331.55 / $683.90