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South Carolina 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
$132.77 / $132.77 / $174.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.93 / $475.00 / $1,108.63
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$99.95 / $140.00 / $377.10
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$220.23 / $335.00 / $462.42
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.18 / $316.24 / $514.82
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$82.70 / $109.67 / $182.62
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$269.02 / $269.02 / $269.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.64 / $660.00 / $1,250.00
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.02 / $265.00 / $391.26
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$192.16 / $395.00 / $825.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.68 / $726.27 / $1,387.96
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$117.16 / $154.75 / $272.72
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$251.66 / $549.14 / $1,148.31
Medcost
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$183.65 / $215.00 / $380.70
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.42 / $300.42 / $1,210.46
Medcost
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$400.02 / $400.02 / $400.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.53 / $210.04 / $363.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.80 / $588.20 / $1,368.10
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$111.43 / $147.36 / $234.31
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$239.68 / $377.43 / $1,072.40