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Pennsylvania rates for HCPCS C8903

Magnetic Resonance Imaging With Contrast Breast; Unilateral (Special Coverage Instructions Apply)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$414.38 / $816.00 / $2,105.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.75 / $400.00 / $425.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.51 / $476.08 / $864.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.64 / $889.64 / $889.64
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$376.01 / $634.59 / $634.59
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$425.00 / $1,463.00 / $2,105.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.75 / $425.00 / $1,037.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.44 / $462.21 / $864.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.64 / $889.64 / $889.64