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Maryland rates for HCPCS 77047

Magnetic resonance imaging, breast, without contrast material; bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$64.57 / $64.57 / $89.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $371.54 / $1,412.54
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.57 / $117.49 / $275.42
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$131.83 / $194.98 / $436.52
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $275.42 / $338.84
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.10 / $104.71 / $131.83
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$194.98 / $218.78 / $251.19
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$123.03 / $123.03 / $123.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $302.00 / $562.34
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$58.88 / $87.10 / $169.82
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$123.03 / $199.53 / $380.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $251.19 / $354.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.13 / $83.18 / $114.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$151.36 / $169.82 / $239.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $363.08 / $1,000.00
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.66 / $81.28 / $138.04
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$151.36 / $275.42 / $891.25
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $263.03 / $363.08
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.13 / $87.10 / $114.82
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$147.91 / $177.83 / $245.47