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Washington 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
$13.32 / $26.11 / $42.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.83 / $147.40 / $603.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$13.32 / $37.63 / $263.89
Asuris Northwest Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$70.00 / $80.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.45 / $118.13 / $402.45
Asuris Northwest Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.17 / $28.07 / $96.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.52 / $100.20 / $163.57
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.63 / $21.36 / $37.26
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$13.50 / $24.64 / $32.29
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.90 / $117.86 / $205.77
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$12.88 / $25.90 / $32.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.04 / $54.27 / $92.00
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$18.13 / $23.13 / $23.45
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$14.07 / $21.10 / $25.90
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$15.86 / $15.86 / $16.00
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.20 / $110.24 / $140.72
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$18.04 / $27.09 / $32.81
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.45 / $96.88 / $142.55
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.17 / $24.22 / $32.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.40 / $77.56 / $146.26
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$10.73 / $14.66 / $39.15
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.12 / $52.12 / $52.12
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$12.26 / $12.26 / $12.26