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Michigan rates for HCPCS 75563

Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with stress imaging

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$177.84 / $177.84 / $186.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.18 / $543.73 / $1,115.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.67 / $604.12 / $858.49
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$159.58 / $159.58 / $159.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.97 / $812.99 / $1,427.41
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$117.82 / $117.82 / $177.84
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$460.53 / $543.73 / $845.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.14 / $296.01 / $489.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$455.32 / $606.29 / $1,001.39