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Washington 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
$114.82 / $181.97 / $331.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $524.81 / $2,187.76
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.00 / $165.96 / $537.03
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$281.84 / $416.87 / $1,000.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $691.83 / $1,000.00
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.86 / $177.83 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $812.83 / $1,479.11
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.11 / $151.36 / $302.00
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$323.59 / $660.69 / $1,230.27
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$117.49 / $199.53 / $1,000.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $954.99 / $1,258.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.00 / $186.21 / $257.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$436.52 / $741.31 / $1,071.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $199.53
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$154.88 / $199.53 / $204.17
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $288.40 / $489.78
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$141.25 / $186.21 / $223.87
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$512.86 / $676.08 / $1,096.48
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$138.04 / $138.04 / $138.04
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $954.99 / $1,258.93
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$138.04 / $213.80 / $295.12
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$436.52 / $741.31 / $954.99
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$707.95 / $707.95 / $707.95
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $912.01 / $1,202.26
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$141.25 / $213.80 / $281.84
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$467.74 / $707.95 / $933.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $645.65 / $1,288.25
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.10 / $114.82 / $281.84
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$323.59 / $512.86 / $1,023.29
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $489.78 / $812.83
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.00 / $114.82 / $190.55
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$323.59 / $371.54 / $616.60