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Washington rates for HCPCS 73221

Mri Any Jt Upper Extremity W/O Contrast Matrl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$73.09 / $114.78 / $210.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.91 / $475.00 / $983.25
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$73.11 / $140.00 / $268.00
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$816.81 / $1,218.00 / $1,218.00
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$125.00 / $187.50 / $320.41
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$172.56 / $335.00 / $499.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.99 / $386.04 / $596.61
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.60 / $110.43 / $124.70
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$266.57 / $266.57 / $270.30
Asuris Northwest Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$603.28 / $603.28 / $603.28
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.91 / $501.37 / $2,789.74
Asuris Northwest Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.17 / $152.78 / $542.85
Asuris Northwest Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$363.77 / $529.45 / $1,114.48
Asuris Northwest Health
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$36.53 / $39.40 / $206.83
Asuris Northwest Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$203.74 / $368.45 / $2,451.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.56 / $449.06 / $775.55
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.45 / $117.09 / $202.98
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$159.44 / $324.77 / $665.45
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$71.43 / $146.29 / $698.97
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.16 / $518.87 / $1,141.68
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.55 / $136.61 / $178.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$198.71 / $371.62 / $992.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.39 / $183.24 / $439.80
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$103.35 / $126.07 / $130.65
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.34 / $178.16 / $220.31
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$78.79 / $111.72 / $136.07
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$209.84 / $297.54 / $749.73
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$87.29 / $87.29 / $87.43
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.80 / $492.91 / $614.02
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$99.14 / $150.19 / $181.83
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$226.30 / $342.52 / $434.30
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$446.45 / $446.45 / $782.93
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.91 / $433.19 / $618.96
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.17 / $132.16 / $178.42
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$203.74 / $301.02 / $440.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.48 / $399.84 / $666.14
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$59.68 / $77.26 / $195.79
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$138.66 / $277.32 / $498.96
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.87 / $235.87 / $235.87
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.93 / $66.93 / $66.93
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$168.94 / $168.94 / $168.94