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Illinois 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
$115.26 / $181.01 / $270.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.74 / $475.00 / $1,320.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$115.26 / $183.23 / $596.60
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$163.81 / $204.93 / $302.74
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$228.22 / $335.00 / $462.42
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.90 / $267.52 / $381.03
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$78.43 / $108.93 / $148.78
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$149.74 / $203.93 / $296.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.91 / $377.34 / $913.21
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$146.01 / $146.01 / $146.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.93 / $525.00 / $1,399.95
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$92.04 / $154.30 / $229.81
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$212.37 / $361.60 / $1,120.83
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.80 / $569.22 / $3,820.89
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$131.11 / $187.33 / $806.50
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$243.93 / $382.64 / $2,686.76
Hally Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.01 / $390.68 / $422.85
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$131.11 / $135.29 / $143.27
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$248.72 / $259.58 / $279.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $149.88 / $442.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.32 / $617.34 / $1,195.85
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$111.47 / $145.65 / $253.91
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$250.66 / $421.40 / $902.22