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Idaho rates for HCPCS 77049

Mri Breast Without&With Contrast W/Cad Bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$275.14 / $275.14 / $275.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.18 / $522.50 / $734.02
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$121.46 / $145.65 / $311.07
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$285.82 / $343.92 / $502.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.58 / $337.06 / $693.99
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$91.16 / $101.89 / $205.99
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$210.42 / $235.17 / $484.39
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,315.19 / $1,315.19 / $1,675.84
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$892.00 / $892.00 / $893.84
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$782.00 / $782.00 / $782.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.60 / $639.79 / $842.24
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$173.99 / $184.54 / $210.90
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$381.61 / $404.74 / $462.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $196.38 / $542.99
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.20 / $724.04 / $842.24
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$188.07 / $221.26 / $266.38
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$427.37 / $502.79 / $575.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.26 / $626.70 / $1,321.32
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.29 / $117.65 / $188.24
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$243.26 / $539.23 / $1,010.22