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Wisconsin rates for HCPCS 77047

Magnetic resonance imaging, breast, without contrast material; bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$114.82 / $114.82 / $158.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $338.84 / $870.96
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$67.61 / $114.82 / $346.74
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$125.89 / $190.55 / $354.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $363.08 / $1,230.27
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.13 / $114.82 / $407.38
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$147.91 / $239.88 / $831.76
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$199.53 / $229.09 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $524.81 / $912.01
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$69.18 / $158.49 / $309.03
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$151.36 / $354.81 / $616.60
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $489.78 / $660.69
DeanCare
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$138.04 / $165.96 / $223.87
DeanCare
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$269.15 / $323.59 / $436.52
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$707.95 / $707.95 / $707.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $831.76 / $1,698.24
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.28 / $154.88 / $478.63
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$199.53 / $676.08 / $1,513.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $512.86 / $741.31
Quartz
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$177.83 / $691.83 / $691.83
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $1,230.27 / $1,479.11
Quartz
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$95.50 / $398.11 / $478.63
Quartz
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$208.93 / $831.76 / $1,000.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,412.54 / $1,905.46
Security Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$354.81 / $478.63 / $588.84
Security Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$758.58 / $1,023.29 / $1,258.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $616.60 / $1,659.59
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.28 / $131.83 / $288.40
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$177.83 / $416.87 / $1,513.56