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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
$245.47 / $245.47 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $338.84 / $691.83
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$72.44 / $104.71 / $263.03
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$134.90 / $239.88 / $489.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $812.83 / $891.25
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$147.91 / $245.47 / $281.84
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$416.87 / $489.78 / $549.54
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $630.96 / $1,122.02
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$158.49 / $223.87 / $426.58
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$331.13 / $380.19 / $616.60
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $933.25 / $1,584.89
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$281.84 / $302.00 / $512.86
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$549.54 / $645.65 / $1,071.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $562.34 / $891.25
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.10 / $147.91 / $281.84
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$162.18 / $416.87 / $489.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $933.25 / $1,905.46
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$194.98 / $281.84 / $478.63
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$389.05 / $588.84 / $1,548.82