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West Virginia 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
$110.31 / $121.35 / $200.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.32 / $475.00 / $522.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$110.32 / $228.09 / $235.80
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$208.00 / $335.00 / $368.50
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.22 / $316.12 / $660.30
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$124.22 / $124.22 / $124.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.58 / $802.64 / $4,515.26
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$94.43 / $172.07 / $587.61
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$185.24 / $509.53 / $2,144.96
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$172.11 / $285.37 / $292.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.91 / $760.45 / $1,912.60
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$68.34 / $157.07 / $269.69
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$198.44 / $647.58 / $1,541.35