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Washington rates for HCPCS 77049

Mri Breast Without&With Contrast W/Cad Bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$123.12 / $193.29 / $306.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.20 / $475.00 / $1,001.83
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.14 / $140.00 / $289.50
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$245.66 / $343.92 / $502.80
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.02 / $652.97 / $1,031.57
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$84.97 / $175.26 / $210.79
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$384.48 / $384.48 / $521.33
Asuris Northwest Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$1,020.08 / $1,020.08 / $1,020.08
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$483.05 / $851.76 / $3,037.28
Asuris Northwest Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$149.22 / $257.27 / $896.93
Asuris Northwest Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$351.58 / $602.29 / $2,140.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.22 / $703.98 / $1,147.24
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$108.32 / $198.23 / $343.16
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$261.32 / $505.75 / $821.79
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$128.69 / $229.56 / $299.97
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$422.32 / $830.01 / $1,075.83
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$120.03 / $241.24 / $299.26
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$302.66 / $583.66 / $785.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.02 / $300.95 / $745.03
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$177.65 / $214.53 / $218.42
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$128.72 / $177.65 / $217.08
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$393.21 / $471.65 / $542.70
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$146.32 / $146.32 / $147.61
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$554.67 / $818.73 / $1,006.26
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$167.54 / $250.00 / $303.26
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$387.14 / $577.22 / $714.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.81 / $731.44 / $998.94
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$149.22 / $222.62 / $303.10
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$351.58 / $507.93 / $713.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.26 / $686.53 / $1,235.82
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.56 / $118.28 / $317.54
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$243.26 / $501.11 / $935.72
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.74 / $395.74 / $395.74
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$113.94 / $113.94 / $113.94
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$281.80 / $281.80 / $281.80