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Illinois rates for HCPCS 77047

Mri Breast Without Contrast Material Bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$72.26 / $113.87 / $124.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.33 / $370.50 / $522.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$67.30 / $113.81 / $154.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$127.02 / $203.27 / $348.53
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.38 / $179.07 / $179.07
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.67 / $84.18 / $100.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.96 / $234.55 / $494.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.98 / $310.97 / $473.34
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.28 / $102.44 / $154.94
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$140.51 / $208.21 / $322.56
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.46 / $370.94 / $1,517.84
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.47 / $115.18 / $474.20
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$160.86 / $219.36 / $764.61
Hally Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.72 / $268.14 / $288.76
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.85 / $91.60 / $98.64
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$161.60 / $169.13 / $190.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $103.20 / $302.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.90 / $451.90 / $1,075.25
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.20 / $101.50 / $158.44
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$171.63 / $301.32 / $929.70