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Maine rates for HCPCS 72147

Mri Spinal Canal Thoracic W/Contrast Matrl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$167.00 / $167.00 / $167.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.50 / $475.00 / $600.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$111.15 / $140.00 / $167.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.58 / $392.39 / $572.91
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.97 / $114.30 / $173.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.87 / $564.09 / $943.28
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$90.52 / $135.38 / $189.34
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$341.71 / $411.21 / $741.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$103.46 / $124.50 / $224.59
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.11 / $525.34 / $1,016.00
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$93.30 / $157.07 / $207.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.45 / $445.63 / $790.48
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$90.25 / $127.20 / $224.59