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Utah rates for HCPCS 77047

Magnetic resonance imaging, breast, without contrast material; bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$128.82 / $128.82 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $467.74 / $1,412.54
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.57 / $109.65 / $199.53
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$128.82 / $223.87 / $489.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $302.00 / $630.96
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.10 / $93.33 / $165.96
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$141.25 / $194.98 / $331.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $524.81
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$416.87 / $416.87 / $416.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $426.58 / $537.03
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.71 / $141.25 / $177.83
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$213.80 / $288.40 / $354.81
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $338.84 / $446.68
Select Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.79 / $120.23 / $177.83
Select Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$134.90 / $223.87 / $275.42
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $239.88 / $467.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $467.74 / $831.76
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.07 / $70.79 / $134.90
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$147.91 / $389.05 / $758.58