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Pennsylvania rates for HCPCS 75565

Cardiac magnetic resonance imaging for velocity flow mapping (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$16.39 / $126.00 / $398.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.47 / $370.50 / $475.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.88 / $67.05 / $161.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.88 / $26.88 / $26.88
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$10.82 / $17.01 / $22.16
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.85 / $74.44 / $190.81
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.74 / $19.04 / $27.72
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$13.50 / $13.50 / $13.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.37 / $78.38 / $146.91
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$8.41 / $14.41 / $23.43
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.04 / $70.31 / $196.56
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$12.84 / $15.44 / $24.40
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.73 / $91.53 / $93.33
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$13.01 / $13.94 / $20.98
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$16.39 / $21.72 / $403.20
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.95 / $380.00 / $1,037.00
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.88 / $30.10 / $269.64
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.44 / $97.20 / $129.80
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$13.50 / $13.50 / $13.50
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.50 / $72.25 / $137.30
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$8.53 / $14.38 / $23.86
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$11.62 / $11.62 / $12.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.68 / $45.45 / $83.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.34 / $11.62 / $12.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.56 / $65.81 / $107.68
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$10.80 / $13.65 / $23.73