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Illinois rates for HCPCS 77058

Magnetic Resonance Imaging Breast

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,664.00 / $2,209.58 / $5,261.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$828.98 / $993.21 / $1,662.53
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $345.40 / $345.40
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $40.00