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Illinois rates for HCPCS 77049

Mri Breast Without&With Contrast W/Cad Bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$104.04 / $146.56 / $186.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.26 / $475.00 / $963.30
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$97.92 / $140.00 / $563.94
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$207.01 / $320.70 / $433.05
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.79 / $329.54 / $408.20
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.83 / $101.19 / $149.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.75 / $347.68 / $773.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.87 / $505.22 / $747.77
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$90.90 / $149.27 / $221.60
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$229.54 / $343.45 / $532.13
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$383.27 / $581.88 / $2,499.46
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$127.50 / $188.48 / $726.97
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$261.32 / $356.34 / $1,301.66
Hally Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.89 / $418.87 / $452.96
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$131.91 / $136.10 / $144.13
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$262.50 / $274.79 / $308.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $150.78 / $473.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.07 / $660.05 / $1,275.93
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$86.37 / $126.23 / $223.34
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$280.98 / $478.63 / $948.20