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Alaska rates for HCPCS 77047

Magnetic resonance imaging, breast, without contrast material; bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$237.40 / $237.40 / $237.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$475.00 / $522.50 / $690.22
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$140.00 / $154.00 / $261.45
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$335.00 / $368.50 / $428.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.18 / $664.11 / $818.87
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$113.82 / $245.82 / $280.82
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$219.36 / $418.29 / $558.60
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.75 / $645.29 / $1,426.04
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$181.95 / $223.31 / $549.78
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$330.11 / $426.96 / $876.26
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.25 / $937.30 / $1,582.38
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$281.25 / $303.75 / $507.35
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$550.00 / $640.90 / $1,075.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.30 / $843.75 / $1,514.10
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$245.82 / $340.50 / $507.35
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$493.00 / $721.50 / $1,075.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.48 / $918.72 / $1,904.22
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$109.30 / $304.00 / $465.91
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$387.82 / $585.07 / $1,560.90