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Michigan rates for HCPCS 77049

Mri Breast Without&With Contrast W/Cad Bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$129.53 / $129.53 / $136.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.96 / $475.00 / $696.20
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$101.28 / $140.00 / $412.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$222.00 / $335.00 / $422.10
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.91 / $267.52 / $273.91
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$84.64 / $142.49 / $163.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.34 / $427.27 / $576.62
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$173.63 / $173.63 / $173.63
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.37 / $274.05 / $442.74
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$124.62 / $124.62 / $124.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.84 / $538.20 / $857.60
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.06 / $135.36 / $268.76
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$234.63 / $363.47 / $695.41
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$91.50 / $129.53 / $133.40
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.12 / $408.01 / $615.62
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$91.50 / $129.53 / $389.19
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$220.61 / $278.48 / $428.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.51 / $230.37 / $378.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$344.74 / $630.19 / $1,087.36
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.91 / $105.10 / $145.26
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$261.93 / $539.28 / $910.20