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Washington rates for HCPCS 71555

Mra Chest W/O & W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$96.00 / $188.69 / $308.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.00 / $475.00 / $1,061.18
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$86.72 / $140.00 / $380.94
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$282.87 / $359.77 / $790.43
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.91 / $631.91 / $631.91
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$135.68 / $135.68 / $135.68
Asuris Northwest Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$793.04 / $793.04 / $793.04
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.95 / $866.52 / $3,032.66
Asuris Northwest Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$116.89 / $201.07 / $854.80
Asuris Northwest Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$376.60 / $669.16 / $2,562.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.96 / $725.17 / $1,198.19
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$84.20 / $153.97 / $266.67
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$285.45 / $565.44 / $922.71
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$99.05 / $179.57 / $233.51
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.07 / $865.24 / $1,407.61
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$93.89 / $188.70 / $233.24
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$353.71 / $678.05 / $1,149.67
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.20 / $318.25 / $770.64
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$138.05 / $166.34 / $170.85
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$117.97 / $153.60 / $180.34
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$396.26 / $556.16 / $738.84
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$114.61 / $114.61 / $114.71
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$538.17 / $811.02 / $980.56
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$130.94 / $194.27 / $236.81
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$407.25 / $613.38 / $755.09
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.95 / $712.76 / $1,041.09
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$116.89 / $173.69 / $234.52
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$370.06 / $539.07 / $799.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.61 / $514.41 / $1,059.95
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.92 / $96.26 / $247.42
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$253.69 / $424.36 / $814.59
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.97 / $387.97 / $387.97
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$88.13 / $88.13 / $88.13
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$299.83 / $299.83 / $299.83