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Wisconsin 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
$229.09 / $295.12 / $295.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $426.58 / $724.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $446.68 / $1,659.59
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$288.40 / $338.84 / $537.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $676.08 / $1,174.90
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $616.60 / $851.14
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $707.95 / $3,162.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $398.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $707.95 / $1,258.93
Quartz
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$257.04 / $1,000.00 / $1,000.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $1,548.82 / $3,162.28
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,778.28 / $2,398.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $562.34 / $1,202.26