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Wisconsin rates for HCPCS C8902

Magnetic Resonance Angiography Without Contrast Followed By With Contrast Abdomen (Special Coverage Instructions Apply)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.75 / $318.75 / $318.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.75 / $318.75 / $397.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,338.15 / $1,338.15 / $1,338.15
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.75 / $318.75 / $478.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.75 / $318.75 / $573.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,438.18 / $1,438.18 / $1,438.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $70.00 / $619.67
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.75 / $318.75 / $478.13
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$975.64 / $975.64 / $975.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,338.15 / $1,338.15 / $1,338.15