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New Hampshire rates for HCPCS 72157

Mri Spinal Canal Thoracic W/O & W/Contr Matrl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$127.50 / $207.84 / $472.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.00 / $475.00 / $1,320.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$118.59 / $140.00 / $389.19
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$281.41 / $335.00 / $931.29
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.00 / $258.57 / $766.65
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.87 / $195.79 / $347.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.70 / $674.51 / $967.17
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$105.13 / $224.61 / $317.64
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$210.58 / $449.91 / $645.12
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$154.12 / $154.12 / $154.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.80 / $754.79 / $1,700.74
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$134.44 / $220.79 / $321.89
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$293.76 / $515.77 / $1,390.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.41 / $625.16 / $1,190.52
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$120.35 / $198.40 / $396.44
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$241.07 / $428.43 / $794.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.77 / $596.71 / $1,302.54
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$116.94 / $152.47 / $310.29
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$321.24 / $385.44 / $1,014.03
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$466.51 / $568.38 / $852.57
Well Sense
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$88.08 / $109.22 / $147.66
Well Sense
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$375.71 / $454.12 / $707.12