go back

Maine rates for HCPCS 72126

Computed tomography, cervical spine; with contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$69.76 / $69.76 / $69.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.63 / $282.06 / $340.04
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.46 / $58.24 / $69.76
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$136.09 / $229.59 / $281.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.31 / $239.82 / $354.53
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.16 / $78.29 / $118.18
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$124.60 / $161.24 / $236.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.67 / $333.46 / $513.00
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.95 / $91.80 / $129.52
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$147.87 / $234.36 / $409.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.46 / $254.46 / $459.04
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.48 / $84.82 / $153.02
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$140.97 / $169.64 / $306.02
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.11 / $285.52 / $365.15
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.46 / $63.62 / $126.59
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$133.36 / $214.72 / $285.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.96 / $310.97 / $492.87
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$62.44 / $87.12 / $143.93
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$136.21 / $223.85 / $317.58