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Maine rates for HCPCS 72125

Ct Cervical Spine W/O Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$56.96 / $57.25 / $64.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.19 / $221.75 / $267.14
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.14 / $51.59 / $78.73
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$110.40 / $160.94 / $217.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.24 / $184.08 / $273.68
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.70 / $64.40 / $96.75
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$91.71 / $119.68 / $176.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.98 / $260.64 / $441.00
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.16 / $77.69 / $106.37
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$114.11 / $173.59 / $341.00
Community Health Options
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.75 / $185.75 / $185.75
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.22 / $196.42 / $354.34
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.71 / $69.44 / $125.28
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$105.52 / $126.99 / $229.06
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$53.97 / $57.25 / $65.73
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.61 / $208.84 / $282.33
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.89 / $57.25 / $98.59
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$101.95 / $136.51 / $221.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.07 / $253.99 / $367.41
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.66 / $76.62 / $118.12
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.12 / $175.41 / $266.23