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Maine rates for HCPCS 77047

Mri Breast Without Contrast Material Bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$90.70 / $90.70 / $90.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.38 / $425.00 / $494.18
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$90.71 / $127.50 / $145.65
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$194.67 / $297.50 / $348.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.21 / $314.74 / $459.58
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.27 / $102.59 / $155.50
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$163.77 / $211.94 / $304.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.04 / $373.81 / $704.71
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$86.39 / $120.32 / $169.74
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$175.06 / $253.49 / $353.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.11 / $321.58 / $595.04
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$92.75 / $111.61 / $201.34
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$181.37 / $218.25 / $393.72
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.22 / $425.00 / $546.25
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.65 / $127.50 / $161.00
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$179.56 / $276.50 / $368.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.91 / $648.17 / $872.55
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.03 / $116.22 / $190.94
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$157.88 / $405.25 / $732.29