go back

Maine rates for HCPCS 71555

Magnetic resonance angiography, chest (excluding myocardium), with or without contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$165.96 / $165.96 / $165.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $478.63 / $1,778.28
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.11 / $131.83 / $302.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$257.04 / $338.84 / $870.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $489.78 / $1,202.26
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.18 / $120.23 / $275.42
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$251.19 / $363.08 / $933.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $660.69 / $1,148.15
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.11 / $125.89 / $239.88
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$309.03 / $501.19 / $912.01
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $512.86 / $977.24
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.00 / $125.89 / $234.42
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$302.00 / $389.05 / $758.58
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $602.56 / $1,202.26
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.71 / $147.91 / $281.84
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$281.84 / $436.52 / $933.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $549.54 / $1,000.00
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.13 / $125.89 / $234.42
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$269.15 / $416.87 / $812.83