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Pennsylvania rates for HCPCS 72142

Mri Spinal Canal Cervical W/Contrast Matrl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$117.98 / $127.23 / $398.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.87 / $425.00 / $577.30
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.02 / $126.00 / $230.63
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$195.98 / $289.48 / $368.50
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.70 / $166.70 / $182.33
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.91 / $65.91 / $87.51
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.80 / $358.59 / $593.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.18 / $110.40 / $167.70
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$185.62 / $248.19 / $420.65
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$97.16 / $97.16 / $97.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.93 / $526.85 / $968.50
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.26 / $106.98 / $173.03
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$175.11 / $381.47 / $786.67
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.73 / $433.94 / $1,517.63
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$93.44 / $112.03 / $176.44
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$222.16 / $276.58 / $393.93
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.83 / $318.83 / $318.83
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$94.53 / $105.27 / $805.35
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$117.98 / $127.23 / $403.20
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.62 / $425.00 / $1,192.00
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.49 / $126.00 / $241.40
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$200.14 / $299.00 / $537.11
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.90 / $283.60 / $700.00
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$63.35 / $97.16 / $97.16
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.47 / $502.60 / $931.41
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.23 / $107.12 / $173.03
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$177.12 / $381.47 / $783.04
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$84.26 / $84.26 / $100.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.02 / $276.14 / $595.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$82.07 / $84.32 / $100.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$187.70 / $191.90 / $495.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.98 / $395.75 / $725.77
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$80.80 / $100.66 / $166.74
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$192.97 / $278.54 / $589.66