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Alaska rates for HCPCS 72149

Mri Spinal Canal Lumbar W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$265.02 / $265.02 / $265.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.00 / $522.50 / $1,501.70
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$140.00 / $154.00 / $519.54
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$335.00 / $368.50 / $982.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$413.40 / $1,014.17 / $1,055.00
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$129.02 / $290.32 / $312.83
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$284.37 / $717.50 / $738.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$665.53 / $798.63 / $1,830.00
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$204.60 / $249.77 / $614.13
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$427.48 / $553.14 / $1,134.32
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.75 / $1,180.40 / $1,953.39
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$316.25 / $341.55 / $573.75
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$712.50 / $828.10 / $1,387.94
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.82 / $1,043.75 / $1,917.30
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$273.45 / $379.50 / $565.46
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$711.60 / $931.50 / $1,387.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.74 / $1,126.10 / $3,353.00
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$122.32 / $375.42 / $1,079.00
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$500.46 / $755.00 / $2,274.00