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Idaho rates for HCPCS 72149

Mri Spinal Canal Lumbar W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$218.85 / $218.85 / $218.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.29 / $475.00 / $861.95
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$95.74 / $140.00 / $268.36
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$269.55 / $348.53 / $593.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.71 / $263.44 / $737.78
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
$164.90 / $184.30 / $543.20
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,701.50 / $1,701.50 / $1,888.82
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$352.69 / $352.69 / $752.88
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$948.62 / $948.62 / $1,536.13
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.25 / $505.80 / $662.18
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$135.04 / $155.50 / $181.68
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$304.23 / $350.32 / $409.32
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $152.41 / $429.00
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
$486.18 / $571.98 / $662.17
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$146.15 / $171.94 / $207.01
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$340.03 / $400.04 / $455.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.11 / $456.54 / $962.57
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.36 / $97.89 / $172.05
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.49 / $346.98 / $788.61