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Vermont rates for HCPCS 77047

Mri Breast Without Contrast Material Bilateral

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.00 / $425.00 / $522.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$127.50 / $127.50 / $154.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$297.50 / $297.50 / $368.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.02 / $366.64 / $976.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.53 / $353.19 / $976.07
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$103.84 / $112.27 / $318.50
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$221.26 / $234.13 / $446.76
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.53 / $352.84 / $976.07
MVP Health Care
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$103.84 / $112.27 / $318.50
MVP Health Care
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$221.26 / $233.99 / $389.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.51 / $533.08 / $1,367.35
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$78.86 / $113.25 / $303.33
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$173.59 / $359.13 / $1,214.33