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Pennsylvania 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
$114.73 / $154.85 / $374.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.60 / $460.60 / $1,972.45
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$108.70 / $175.13 / $498.26
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$163.31 / $201.04 / $237.50
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$217.91 / $299.00 / $783.89
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.35 / $249.35 / $305.48
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$82.06 / $111.64 / $179.40
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$126.23 / $190.98 / $319.70
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.76 / $484.88 / $2,862.80
AmeriHealth
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$126.14 / $146.88 / $1,568.03
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.35 / $562.54 / $1,788.31
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$139.47 / $176.14 / $275.20
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$269.79 / $381.42 / $1,578.86
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
$282.95 / $647.37 / $1,391.92
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$78.52 / $135.25 / $215.67
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$194.00 / $470.06 / $1,175.91
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$378.16 / $501.77 / $2,221.21
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$119.16 / $142.80 / $225.10
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$246.10 / $306.43 / $436.48
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.22 / $383.05 / $664.69
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$120.41 / $135.38 / $202.10
Highmark BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$315.66 / $383.37 / $386.79
Independence Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.38 / $460.05 / $2,009.87
Independence Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$121.78 / $146.88 / $1,568.03
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$109.27 / $156.26 / $412.02
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.85 / $475.00 / $1,630.00
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.53 / $161.00 / $374.22
Martin's Point
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$164.80 / $212.50 / $435.30
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$220.57 / $304.38 / $827.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.10 / $328.75 / $700.00
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$77.68 / $123.88 / $123.88
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.05 / $640.25 / $1,319.26
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.84 / $133.87 / $221.45
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$198.98 / $451.04 / $1,132.36
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$107.53 / $107.53 / $122.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.45 / $319.95 / $1,040.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.78 / $107.58 / $122.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$207.89 / $212.43 / $918.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.33 / $476.01 / $1,048.15
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.51 / $126.72 / $212.55
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$213.66 / $308.62 / $852.16