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Maine rates for HCPCS 72125

Computed tomography, cervical spine; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$53.70 / $57.54 / $323.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $208.93 / $562.34
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.65 / $53.70 / $154.88
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$81.28 / $120.23 / $309.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $190.55 / $478.63
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $66.07 / $158.49
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$85.11 / $123.03 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $281.84 / $588.84
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.48 / $70.79 / $131.83
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$109.65 / $194.98 / $398.11
Community Health Options
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $186.21 / $186.21
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $199.53 / $389.05
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.23 / $70.79 / $141.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$102.33 / $128.82 / $251.19
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$53.70 / $57.54 / $323.59
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $218.78 / $489.78
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.71 / $63.10 / $128.82
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$100.00 / $138.04 / $331.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $251.19 / $436.52
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.98 / $75.86 / $131.83
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.72 / $173.78 / $302.00