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Arizona 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
$136.65 / $210.16 / $404.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$334.68 / $475.00 / $1,287.97
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$111.15 / $154.00 / $498.26
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$125.00 / $202.92 / $278.89
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$236.47 / $335.00 / $572.35
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.56 / $270.25 / $319.76
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$82.45 / $144.94 / $191.37
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$203.93 / $203.93 / $203.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.08 / $365.81 / $457.26
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$94.60 / $108.11 / $135.13
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$225.48 / $257.70 / $322.12
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$123.88 / $123.88 / $123.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.08 / $642.59 / $1,174.21
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$80.04 / $136.88 / $235.95
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$183.57 / $426.21 / $994.34
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$1,013.76 / $1,013.76 / $1,013.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.04 / $724.72 / $6,146.58
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$95.99 / $117.29 / $921.60
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$215.34 / $542.35 / $5,551.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.04 / $526.40 / $921.84
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$95.99 / $100.22 / $212.55
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$215.34 / $372.06 / $770.04