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Indiana rates for HCPCS 77047

Magnetic resonance imaging, breast, without contrast material; bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$70.48 / $70.48 / $657.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.61 / $218.05 / $475.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.36 / $72.98 / $140.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$127.02 / $145.79 / $335.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.62 / $173.62 / $173.62
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.71 / $84.18 / $105.23
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$601.25 / $601.25 / $601.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.29 / $241.52 / $374.35
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.22 / $78.43 / $121.56
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$125.07 / $163.09 / $252.78
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.66 / $163.68 / $271.47
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$86.45 / $86.45 / $86.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.48 / $293.83 / $476.95
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$71.18 / $94.66 / $161.66
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$140.88 / $198.30 / $313.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.13 / $511.99 / $1,120.22
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$71.27 / $85.26 / $170.85
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$156.22 / $360.53 / $943.83