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Washington 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
$72.68 / $109.02 / $208.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.36 / $475.00 / $1,006.86
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$72.68 / $140.00 / $306.00
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$475.00 / $813.03 / $1,084.04
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$125.00 / $187.50 / $319.91
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$175.97 / $335.00 / $502.50
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.58 / $385.41 / $594.78
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.60 / $107.09 / $123.82
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$265.94 / $265.94 / $311.80
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
$292.45 / $524.36 / $2,791.06
Asuris Northwest Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.17 / $157.91 / $530.54
Asuris Northwest Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$363.20 / $528.61 / $1,139.16
Asuris Northwest Health
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$36.53 / $36.53 / $206.44
Asuris Northwest Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$203.28 / $368.45 / $2,451.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.19 / $448.35 / $781.78
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.76 / $117.09 / $202.98
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$159.07 / $325.41 / $672.66
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$71.43 / $145.38 / $698.97
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.16 / $518.87 / $1,161.67
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.55 / $136.61 / $176.64
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$198.71 / $371.62 / $1,012.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.29 / $183.24 / $439.80
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$104.98 / $126.07 / $129.97
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.34 / $160.34 / $178.16
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.18 / $116.58 / $147.16
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$199.01 / $308.57 / $633.50
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
$325.27 / $492.13 / $612.14
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$98.63 / $149.91 / $181.83
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$226.30 / $341.73 / $431.66
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
$292.45 / $432.50 / $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
$203.28 / $302.72 / $440.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.56 / $406.74 / $665.08
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$58.90 / $76.30 / $189.12
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$138.66 / $285.48 / $504.22
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.48 / $235.48 / $235.48
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
$168.54 / $168.54 / $168.54