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Alaska rates for HCPCS 70553

Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$340.02 / $739.50 / $833.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.00 / $541.72 / $1,778.28
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$140.00 / $167.64 / $666.58
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$706.51 / $889.14 / $889.14
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$335.00 / $368.50 / $1,111.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.91 / $1,125.00 / $1,190.00
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$165.32 / $337.50 / $372.70
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$322.58 / $787.50 / $833.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$633.60 / $942.24 / $2,447.96
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$262.00 / $320.11 / $787.16
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$485.38 / $627.84 / $1,284.20
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,213.75 / $1,385.80 / $2,295.35
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$405.00 / $437.40 / $731.25
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$808.75 / $938.15 / $1,568.97
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.43 / $1,227.50 / $2,249.10
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$337.50 / $487.50 / $726.38
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$787.50 / $1,053.00 / $1,568.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$887.60 / $1,339.04 / $1,886.15
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$161.03 / $334.79 / $683.78
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$565.82 / $853.60 / $1,473.48