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Wisconsin rates for HCPCS 70555

Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofunctional testing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$247.88 / $247.88 / $277.63
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$309.99 / $362.24 / $481.45
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$535.50 / $535.50 / $535.50
Quartz
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$281.58 / $535.50 / $535.50