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Pennsylvania rates for HCPCS 73721

Mri Any Jt Lower Extrem W/O Contrast Matrl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$66.50 / $114.32 / $241.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.52 / $402.08 / $1,263.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.42 / $135.44 / $351.38
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$475.00 / $475.00 / $475.00
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$103.14 / $187.50 / $218.88
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$142.93 / $299.00 / $729.56
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.11 / $153.27 / $195.96
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.54 / $66.18 / $105.72
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$101.09 / $134.86 / $211.56
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.21 / $305.44 / $1,012.94
AmeriHealth
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.37 / $95.98 / $982.81
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.79 / $353.39 / $819.35
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$82.23 / $104.36 / $156.72
Capital Blue Cross
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$527.59 / $706.77 / $1,638.66
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$179.66 / $245.30 / $700.08
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$73.64 / $73.64 / $73.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.52 / $386.75 / $825.44
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.07 / $77.87 / $128.86
Cigna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$301.29 / $343.71 / $343.71
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$126.63 / $304.56 / $683.58
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.23 / $320.14 / $764.91
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.16 / $84.28 / $132.97
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$162.86 / $202.65 / $288.57
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.63 / $241.66 / $415.54
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$68.48 / $80.20 / $111.76
Highmark BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$515.76 / $515.76 / $515.76
Highmark BCBS
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$39.40 / $128.94 / $129.32
Highmark BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$211.63 / $253.61 / $416.00
Independence Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.54 / $305.44 / $546.75
Independence Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$67.42 / $86.85 / $800.65
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$65.42 / $96.20 / $398.16
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.44 / $375.00 / $1,325.96
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.42 / $126.00 / $334.40
Martin's Point
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$270.88 / $475.00 / $475.00
Martin's Point
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$104.19 / $185.25 / $295.38
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$142.94 / $299.00 / $729.56
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.20 / $212.48 / $550.10
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$44.19 / $73.64 / $73.64
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.79 / $368.52 / $780.69
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.66 / $77.08 / $130.80
Priority Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$301.29 / $343.71 / $366.14
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$128.33 / $289.06 / $673.30
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$63.71 / $63.71 / $89.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.50 / $202.48 / $510.50
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$62.09 / $63.72 / $89.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$135.78 / $138.78 / $421.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.82 / $302.14 / $573.34
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$59.20 / $72.95 / $134.36
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$137.57 / $198.71 / $468.78