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Wisconsin rates for HCPCS 77058

Mri Breast Unilateral

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,659.59 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,778.28 / $2,041.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $2,754.23 / $2,754.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $3,801.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $54.95 / $70.79
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $2,754.23 / $2,754.23
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $3,801.89 / $3,801.89