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Indiana 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
$110.41 / $128.72 / $189.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.62 / $439.65 / $617.27
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$105.16 / $140.00 / $279.66
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$158.22 / $175.87 / $237.50
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$198.80 / $269.98 / $426.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.48 / $249.14 / $468.96
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$80.45 / $87.15 / $154.76
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$157.79 / $1,079.65 / $1,079.65
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.07 / $596.44 / $864.34
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$122.45 / $175.01 / $227.16
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$269.01 / $439.78 / $659.67
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.60 / $229.48 / $381.03
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
$320.83 / $761.07 / $1,605.38
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.72 / $146.44 / $244.22
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$212.37 / $616.55 / $1,339.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.65 / $555.96 / $1,295.03
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$99.70 / $122.84 / $236.54
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$224.27 / $380.02 / $996.19