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Washington rates for HCPCS 71552

Mri Chest W/O & W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$120.51 / $238.26 / $390.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.08 / $594.34 / $1,470.14
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.00 / $140.00 / $339.72
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$335.00 / $447.88 / $1,073.40
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.04 / $888.85 / $1,000.00
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$184.47 / $184.47 / $184.47
Asuris Northwest Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$714.15 / $1,000.96 / $1,000.96
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$664.94 / $1,177.26 / $5,967.97
Asuris Northwest Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$146.44 / $254.60 / $937.83
Asuris Northwest Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$548.86 / $976.95 / $5,400.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.24 / $1,035.57 / $1,719.79
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$105.64 / $193.73 / $336.73
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$417.28 / $839.44 / $1,447.01
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$118.19 / $242.56 / $1,102.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$578.86 / $1,233.03 / $2,086.55
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.78 / $226.04 / $294.43
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$522.35 / $1,020.91 / $1,774.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.89 / $423.57 / $1,073.12
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$174.35 / $210.53 / $216.41
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.35 / $268.35 / $268.35
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$129.85 / $191.40 / $224.42
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$542.70 / $769.50 / $1,039.74
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$143.60 / $143.60 / $144.87
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$765.00 / $1,145.67 / $1,462.57
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$164.38 / $248.81 / $297.12
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$600.04 / $902.74 / $1,143.92
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
$695.31 / $1,006.86 / $1,493.56
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$146.44 / $219.36 / $295.22
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$548.86 / $793.94 / $1,168.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.94 / $810.17 / $1,564.15
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$97.55 / $123.36 / $314.25
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$380.39 / $609.15 / $1,225.46
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$546.99 / $546.99 / $546.99
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$111.80 / $111.80 / $111.80
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$435.19 / $435.19 / $435.19