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Missouri 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
$131.22 / $157.61 / $240.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.74 / $478.93 / $2,286.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.61 / $180.14 / $582.97
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$196.33 / $237.50 / $295.23
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$269.98 / $335.00 / $1,426.48
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.35 / $231.70 / $280.27
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$80.76 / $113.36 / $171.38
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$179.88 / $179.88 / $179.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.02 / $442.50 / $1,292.94
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$113.00 / $147.66 / $244.73
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$224.03 / $297.52 / $1,048.24
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
$277.72 / $550.00 / $1,341.10
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$95.10 / $156.51 / $268.81
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$189.12 / $387.01 / $1,148.72
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$791.52 / $1,013.76 / $1,013.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.16 / $811.38 / $6,146.58
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$115.17 / $160.22 / $921.60
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$245.74 / $628.46 / $5,551.18
Qualchoice
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$197.09 / $197.09 / $197.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.11 / $532.40 / $1,280.21
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$105.56 / $140.40 / $234.58
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$233.72 / $341.95 / $910.69