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Maine rates for HCPCS 72146

Mri Spinal Canal Thoracic W/O Contrast Matrl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$96.65 / $167.00 / $167.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.26 / $475.00 / $600.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.03 / $140.00 / $167.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$191.95 / $335.00 / $433.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.08 / $273.17 / $401.53
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
$135.30 / $177.69 / $257.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.00 / $393.60 / $913.88
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.47 / $112.82 / $157.52
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$167.03 / $264.74 / $670.65
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.49 / $288.19 / $519.88
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
$153.34 / $184.52 / $332.87
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$96.65 / $96.65 / $96.65
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.22 / $475.00 / $642.44
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$86.35 / $140.00 / $175.42
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$151.74 / $324.81 / $433.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.66 / $315.64 / $588.36
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$76.15 / $106.05 / $175.36
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$144.36 / $199.60 / $359.85