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Maine rates for HCPCS 71555

Mra Chest W/O & W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$167.00 / $167.00 / $167.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.50 / $475.00 / $600.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$111.15 / $140.00 / $167.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$280.01 / $335.00 / $446.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.71 / $481.47 / $700.08
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$82.29 / $114.30 / $174.16
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$274.83 / $365.90 / $525.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$455.76 / $659.36 / $990.73
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.05 / $135.91 / $190.87
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$345.25 / $497.55 / $791.21
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.56 / $502.47 / $906.44
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$103.87 / $125.00 / $225.48
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$313.68 / $377.48 / $680.94
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$404.04 / $570.55 / $878.62
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$93.58 / $145.65 / $186.50
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$297.50 / $433.00 / $530.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$390.13 / $594.19 / $969.36
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$88.49 / $127.95 / $225.48
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$271.33 / $410.54 / $696.42