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Alaska rates for HCPCS 77049

Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$346.74 / $537.03 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $478.63 / $1,778.28
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.71 / $144.54 / $446.68
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$223.87 / $316.23 / $691.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,122.02 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$213.80 / $354.81 / $407.38
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$691.83 / $794.33 / $891.25
Moda Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$537.03 / $602.56 / $645.65
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $977.24 / $1,905.46
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$154.88 / $323.59 / $616.60
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$380.19 / $630.96 / $891.25
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,479.11 / $2,511.89
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$407.38 / $436.52 / $724.44
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$891.25 / $1,047.13 / $1,737.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $891.25 / $1,122.02
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$93.33 / $213.80 / $407.38
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$269.15 / $691.83 / $794.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,380.38 / $2,041.74
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$234.42 / $354.81 / $691.83
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$645.65 / $954.99 / $1,621.81