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New Hampshire 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
$331.13 / $331.13 / $331.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $426.58 / $794.33
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.10 / $141.25 / $269.15
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$208.93 / $302.00 / $588.84
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.71 / $104.71 / $104.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $630.96 / $912.01
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.28 / $190.55 / $275.42
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$186.21 / $436.52 / $691.83
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$107.15 / $107.15 / $107.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $645.65 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.71 / $173.78 / $263.03
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$263.03 / $457.09 / $1,148.15
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $501.19 / $758.58
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$95.50 / $147.91 / $218.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$218.78 / $338.84 / $524.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $501.19 / $912.01
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.28 / $120.23 / $239.88
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$218.78 / $346.74 / $630.96
Well Sense
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$53.70 / $63.10 / $63.10