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New Hampshire rates for HCPCS 75557

Cardiac magnetic resonance imaging for morphology and function without contrast material;

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$446.68 / $446.68 / $446.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $446.68 / $977.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $645.65 / $933.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $645.65 / $1,122.02
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $512.86 / $794.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $501.19 / $870.96
Well Sense
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$69.18 / $81.28 / $81.28