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Washington 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
$122.75 / $201.04 / $357.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.46 / $509.25 / $1,022.33
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$106.81 / $154.00 / $344.64
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$270.86 / $344.22 / $677.69
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.37 / $610.75 / $955.64
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$86.65 / $181.76 / $289.98
Asuris Northwest Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$1,016.96 / $1,016.96 / $1,016.96
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.70 / $795.68 / $6,195.24
Asuris Northwest Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$148.76 / $260.52 / $931.20
Asuris Northwest Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$316.93 / $571.77 / $5,551.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.19 / $706.52 / $1,254.26
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.99 / $198.24 / $354.36
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$245.27 / $488.53 / $935.67
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$119.66 / $248.72 / $1,102.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.49 / $831.88 / $1,724.52
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$113.15 / $240.50 / $313.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$323.39 / $596.82 / $1,439.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.59 / $274.36 / $658.21
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$177.10 / $213.86 / $219.09
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$131.05 / $190.13 / $238.88
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$301.60 / $447.45 / $736.65
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$145.87 / $145.87 / $147.15
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$517.04 / $778.74 / $983.74
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$167.02 / $253.22 / $306.54
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$350.02 / $525.20 / $670.47
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$714.15 / $714.15 / $1,538.06
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.70 / $684.39 / $992.36
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$148.76 / $222.82 / $298.89
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$316.93 / $461.56 / $693.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.11 / $536.77 / $1,057.17
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$99.70 / $130.00 / $321.18
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$218.41 / $436.83 / $846.01
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.15 / $370.15 / $370.15
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$113.60 / $113.60 / $113.60
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$256.55 / $256.55 / $256.55