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Missouri rates for HCPCS 73220

Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$129.40 / $148.69 / $232.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.00 / $586.99 / $3,047.76
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$108.07 / $157.12 / $519.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$335.00 / $469.74 / $2,121.39
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.13 / $611.98 / $611.98
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.59 / $106.70 / $152.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.92 / $548.48 / $1,268.65
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$106.04 / $124.27 / $223.50
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$332.88 / $442.13 / $1,045.14
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$116.52 / $116.52 / $116.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.01 / $682.40 / $1,410.23
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$88.85 / $145.46 / $250.28
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$275.47 / $534.39 / $1,219.17
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$745.12 / $953.92 / $953.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.87 / $889.15 / $5,981.06
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$105.21 / $149.88 / $672.78
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$365.46 / $708.25 / $5,438.76
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$703.78 / $703.78 / $703.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.12 / $684.77 / $1,501.63
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.75 / $127.93 / $223.58
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$342.54 / $491.52 / $1,132.84