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Nebraska rates for HCPCS 77049

Mri Breast Without&With Contrast W/Cad Bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$104.71 / $104.71 / $104.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.19 / $475.00 / $2,053.60
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.71 / $216.89 / $382.58
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$231.47 / $291.85 / $598.94
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.19 / $759.68 / $759.68
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$144.41 / $195.57 / $244.37
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$422.98 / $422.98 / $422.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$609.87 / $651.88 / $668.17
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$191.78 / $205.00 / $210.12
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$418.07 / $446.88 / $458.05
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$604.98 / $604.98 / $604.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.01 / $774.05 / $1,018.11
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$137.77 / $239.55 / $309.31
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$316.24 / $528.73 / $708.80
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$1,020.08 / $1,020.08 / $1,020.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$557.52 / $903.55 / $2,337.81
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$97.72 / $218.40 / $687.65
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$389.53 / $649.22 / $1,650.16
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$331.64 / $341.30 / $604.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$668.44 / $820.79 / $1,178.56
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.15 / $240.87 / $570.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$557.52 / $807.68 / $1,009.60
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$97.72 / $218.38 / $279.98
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$379.00 / $571.32 / $937.89