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Ohio rates for HCPCS 77047

Magnetic resonance imaging, breast, without contrast material; bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$72.98 / $132.69 / $263.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.82 / $260.95 / $494.18
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$67.95 / $96.10 / $145.65
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$136.34 / $170.91 / $335.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.91 / $173.62 / $413.85
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.95 / $56.95 / $99.65
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.87 / $265.27 / $485.46
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$68.36 / $89.65 / $157.62
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$137.84 / $177.24 / $316.72
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.30 / $142.71 / $221.01
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$78.53 / $86.45 / $86.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.44 / $308.45 / $527.63
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.70 / $101.63 / $171.32
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$135.05 / $207.38 / $353.11
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$78.53 / $78.53 / $86.45
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.48 / $308.45 / $516.89
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.45 / $102.60 / $174.43
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$142.03 / $200.69 / $348.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.94 / $153.55 / $296.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.78 / $355.33 / $985.22
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.56 / $89.62 / $163.63
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$151.74 / $218.31 / $814.47