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Idaho rates for HCPCS 77047

Magnetic resonance imaging, breast, without contrast material; bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$191.50 / $191.50 / $191.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.22 / $467.23 / $522.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$84.65 / $140.00 / $160.93
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$173.41 / $306.30 / $348.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.98 / $213.45 / $437.87
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.28 / $70.73 / $144.04
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$127.70 / $142.72 / $293.79
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,089.77 / $1,089.77 / $1,209.74
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$550.26 / $550.26 / $550.26
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$539.51 / $539.51 / $539.51
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.92 / $408.69 / $492.13
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$120.09 / $127.37 / $145.56
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$234.83 / $249.06 / $284.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $136.16 / $347.85
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$446.45 / $446.45 / $446.45
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.02 / $462.38 / $539.04
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$130.41 / $153.44 / $185.38
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$262.60 / $308.94 / $353.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.18 / $481.43 / $1,074.06
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$67.42 / $81.92 / $154.35
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$147.55 / $387.72 / $962.57