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New Hampshire rates for HCPCS 72142

Mri Spinal Canal Cervical W/Contrast Matrl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$127.97 / $352.04 / $352.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.50 / $457.14 / $600.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$111.15 / $127.50 / $140.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$259.35 / $335.00 / $480.00
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$62.09 / $65.91 / $65.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.06 / $579.14 / $830.42
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$82.16 / $175.54 / $248.24
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$188.90 / $403.60 / $578.72
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$114.91 / $114.91 / $114.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.66 / $648.58 / $1,335.18
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$105.16 / $173.20 / $251.88
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$263.51 / $461.41 / $1,116.15
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.31 / $551.48 / $1,022.19
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$94.06 / $154.72 / $290.32
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$216.26 / $384.34 / $712.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.21 / $622.53 / $1,104.05
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$88.37 / $118.51 / $242.00
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$286.05 / $333.73 / $662.90
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.30 / $523.55 / $769.63
Well Sense
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$68.84 / $85.36 / $111.30
Well Sense
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$364.81 / $437.27 / $597.11