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Pennsylvania rates for HCPCS 72157

Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; thoracic

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$109.65 / $204.17 / $426.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $549.54 / $2,398.83
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.15 / $208.93 / $512.86
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$218.78 / $338.84 / $870.96
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $281.84 / $436.52
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$97.72 / $154.88 / $204.17
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$117.49 / $190.55 / $275.42
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $501.19 / $1,230.27
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$114.82 / $154.88 / $281.84
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$218.78 / $331.13 / $1,122.02
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$26.92 / $123.03 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $630.96 / $1,318.26
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.28 / $144.54 / $245.47
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$208.93 / $446.68 / $1,096.48
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $446.68 / $1,445.44
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.15 / $141.25 / $173.78
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$229.09 / $295.12 / $371.54
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $562.34 / $1,047.13
Geisinger
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.33 / $138.04 / $257.04
Geisinger
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$213.80 / $426.58 / $794.33
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $407.38 / $645.65
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$120.23 / $134.90 / $190.55
Highmark BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$389.05 / $398.11 / $1,000.00
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$109.65 / $194.98 / $416.87
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $537.03 / $1,479.11
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.65 / $173.78 / $371.54
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$229.09 / $363.08 / $851.14
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $562.34 / $741.31
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$107.15 / $107.15 / $107.15
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $676.08 / $691.83
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.71 / $107.15 / $112.20
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$208.93 / $213.80 / $234.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $467.74 / $1,071.52
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$97.72 / $123.03 / $208.93
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$208.93 / $309.03 / $891.25