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New Hampshire rates for HCPCS 77049

Mri Breast Without&With Contrast W/Cad Bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$127.50 / $127.50 / $164.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.50 / $454.80 / $589.03
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$111.15 / $140.00 / $229.50
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$259.35 / $312.27 / $431.70
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.91 / $273.91 / $275.95
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$84.64 / $121.82 / $348.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.73 / $719.44 / $1,031.59
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$105.45 / $225.30 / $318.61
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$231.28 / $494.14 / $708.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.43 / $756.83 / $1,077.61
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$134.85 / $220.10 / $322.89
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$310.70 / $529.50 / $754.73
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.48 / $685.08 / $1,269.81
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$120.72 / $214.54 / $397.66
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$264.76 / $470.53 / $872.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.39 / $605.76 / $1,538.06
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.16 / $152.94 / $229.41
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$357.80 / $586.44 / $1,214.22
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.98 / $429.80 / $649.12
Well Sense
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$88.00 / $105.13 / $142.22
Well Sense
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$277.63 / $326.62 / $450.19