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Alaska rates for HCPCS 71555

Magnetic resonance angiography, chest (excluding myocardium), with or without contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$266.79 / $266.79 / $266.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.00 / $522.50 / $1,830.45
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$140.00 / $154.00 / $523.01
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$335.00 / $368.50 / $1,307.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$507.20 / $1,125.00 / $1,256.63
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$127.54 / $292.60 / $337.50
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$379.66 / $787.50 / $964.02
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$810.21 / $983.01 / $2,130.32
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$203.78 / $250.61 / $617.32
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$570.74 / $738.48 / $1,513.05
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,266.25 / $1,461.20 / $2,416.04
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$315.00 / $340.20 / $567.69
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$951.25 / $1,103.70 / $1,848.35
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.51 / $1,287.50 / $2,377.19
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$276.51 / $381.00 / $567.69
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$833.00 / $1,240.50 / $1,848.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$839.41 / $955.38 / $2,446.16
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$123.74 / $251.91 / $671.03
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$666.37 / $704.72 / $1,775.13