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Washington rates for HCPCS 70553

Mri Brain Brain Stem W/O W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$122.75 / $192.71 / $352.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.52 / $522.50 / $1,042.61
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$108.94 / $156.35 / $395.29
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$174.43 / $213.36 / $507.18
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$269.19 / $347.55 / $687.85
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.74 / $603.97 / $944.66
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$86.39 / $186.78 / $211.10
Ambetter
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$603.97 / $603.97 / $603.97
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$157.79 / $402.23 / $471.69
Asuris Northwest Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$1,013.76 / $1,013.76 / $1,013.76
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.46 / $790.13 / $6,146.58
Asuris Northwest Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$148.76 / $259.85 / $921.60
Asuris Northwest Health
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$61.81 / $61.81 / $320.58
Asuris Northwest Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$313.70 / $564.01 / $5,551.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.62 / $707.11 / $1,330.97
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.66 / $198.24 / $341.01
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$242.94 / $487.28 / $1,008.01
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$119.66 / $245.61 / $1,102.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.92 / $825.75 / $1,814.06
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$106.69 / $231.56 / $298.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$319.99 / $601.91 / $1,551.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.59 / $274.36 / $658.21
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$176.55 / $213.20 / $219.09
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.17 / $298.17 / $298.17
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$131.05 / $196.20 / $238.71
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$298.39 / $495.13 / $897.50
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$145.87 / $145.87 / $146.69
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$513.44 / $773.23 / $972.50
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$167.02 / $252.43 / $305.58
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$346.42 / $520.47 / $664.44
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$714.15 / $714.15 / $1,538.06
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.46 / $679.54 / $985.00
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$148.76 / $222.13 / $298.89
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$313.70 / $457.41 / $686.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.04 / $628.09 / $1,143.94
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$99.70 / $128.22 / $316.57
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$215.34 / $433.84 / $817.18
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.17 / $368.17 / $368.17
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$113.20 / $113.20 / $113.20
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$254.97 / $254.97 / $254.97