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Alaska rates for HCPCS 70552

Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$265.02 / $265.02 / $265.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.00 / $522.50 / $1,500.20
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$140.00 / $154.00 / $519.54
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$599.53 / $750.10 / $750.10
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$335.00 / $368.50 / $980.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$412.93 / $1,009.34 / $1,055.00
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$127.07 / $290.32 / $312.83
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$285.86 / $717.50 / $738.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.35 / $799.62 / $1,747.41
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$202.98 / $248.92 / $613.09
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$429.76 / $556.04 / $1,134.32
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,030.00 / $1,175.20 / $1,942.22
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$313.75 / $338.85 / $571.50
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$716.25 / $830.85 / $1,382.08
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.58 / $1,042.50 / $1,906.80
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$273.45 / $379.50 / $565.46
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$711.60 / $924.00 / $1,376.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$746.70 / $1,120.05 / $1,586.74
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$121.74 / $375.42 / $531.85
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$496.42 / $748.90 / $1,054.89