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Maine rates for HCPCS 72142

Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with 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
$302.00 / $457.09 / $1,122.02
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.10 / $125.89 / $281.84
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$213.80 / $302.00 / $660.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $407.38 / $1,023.29
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.18 / $123.03 / $275.42
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.55 / $281.84 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $630.96 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.11 / $128.82 / $239.88
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$234.42 / $501.19 / $831.76
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $416.87 / $812.83
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
$229.09 / $295.12 / $575.44
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $549.54 / $1,122.02
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.71 / $154.88 / $281.84
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$245.47 / $371.54 / $831.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $457.09 / $933.25
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.13 / $128.82 / $234.42
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$208.93 / $323.59 / $660.69