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Washington 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
$123.03 / $245.47 / $398.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $426.58 / $1,445.44
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $263.03 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $549.54 / $933.25
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$131.83 / $213.80 / $630.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $616.60 / $812.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $109.65
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$177.83 / $218.78 / $223.87
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$147.91 / $147.91 / $147.91
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $645.65 / $831.76
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$446.68 / $446.68 / $446.68
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $602.56 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $407.38 / $851.14
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $331.13 / $549.54