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Pennsylvania 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
$126.00 / $161.04 / $398.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.05 / $425.00 / $1,068.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.98 / $266.98 / $266.98
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.50 / $283.82 / $578.90
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$125.89 / $125.89 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.99 / $465.91 / $842.90
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.02 / $432.37 / $1,087.18
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.03 / $354.03 / $555.53
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$126.00 / $164.51 / $403.20
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.72 / $425.00 / $1,320.50
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.05 / $502.07 / $681.20
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$125.89 / $125.89 / $125.89
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.02 / $453.13 / $815.33
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$108.95 / $108.95 / $128.12
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.19 / $279.98 / $491.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.10 / $403.14 / $645.90