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South Carolina 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
$78.65 / $78.66 / $97.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.00 / $425.00 / $1,240.20
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.04 / $118.59 / $435.75
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$252.40 / $252.40 / $465.80
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$103.14 / $123.69 / $212.50
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$168.71 / $335.00 / $458.92
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.27 / $186.32 / $200.29
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.02 / $64.52 / $107.44
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$279.48 / $279.48 / $279.48
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$104.65 / $176.83 / $226.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.32 / $460.00 / $744.96
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$60.02 / $140.00 / $214.52
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$126.31 / $320.00 / $562.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.01 / $475.46 / $812.27
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$61.68 / $84.35 / $150.22
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$159.51 / $355.12 / $682.68
Medcost
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$97.46 / $130.00 / $228.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.72 / $187.72 / $759.07
Medcost
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$281.58 / $281.58 / $1,138.60
Medcost
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$519.73 / $519.73 / $519.73
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.54 / $140.61 / $242.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.93 / $362.54 / $736.68
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$61.59 / $83.15 / $138.51
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$147.75 / $213.71 / $634.97