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Michigan rates for HCPCS 72149

Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$109.65 / $109.65 / $114.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $457.09 / $870.96
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.11 / $141.25 / $398.11
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.55 / $331.13 / $630.96
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.86 / $79.43 / $83.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $407.38 / $436.52
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$134.90 / $134.90 / $181.97
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$302.00 / $302.00 / $302.00
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$20.89 / $97.72 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $512.86 / $1,000.00
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.79 / $112.20 / $245.47
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$194.98 / $363.08 / $794.33
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$75.86 / $173.78 / $204.17
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $467.74 / $870.96
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.13 / $114.82 / $269.15
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$199.53 / $338.84 / $645.65
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$20.89 / $97.72 / $138.04
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $446.68 / $1,000.00
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.57 / $95.50 / $186.21
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$165.96 / $331.13 / $758.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $380.19 / $707.95
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.43 / $93.33 / $147.91
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$199.53 / $269.15 / $575.44