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Maine rates for HCPCS 72141

Mri Spinal Canal Cervical W/O Contrast Matrl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$80.43 / $167.00 / $167.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.70 / $475.00 / $600.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$97.79 / $140.00 / $167.00
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$103.94 / $212.50 / $300.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$175.23 / $335.00 / $433.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.43 / $273.62 / $400.84
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$73.72 / $95.40 / $144.44
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$135.66 / $177.69 / $256.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.00 / $393.60 / $872.38
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.47 / $112.82 / $158.28
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$167.03 / $264.74 / $647.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.08 / $286.44 / $518.99
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$86.15 / $103.67 / $187.01
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$152.93 / $184.02 / $331.98
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$80.43 / $97.93 / $490.35
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.06 / $475.00 / $655.50
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$84.87 / $140.00 / $176.25
Martin's Point
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$110.13 / $212.50 / $300.00
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$151.34 / $324.81 / $433.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.51 / $317.02 / $540.34
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$73.38 / $106.05 / $187.01
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$144.36 / $211.73 / $359.85