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Maine rates for HCPCS 72149

Mri Spinal Canal Lumbar W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$97.17 / $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
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$259.35 / $335.00 / $433.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.73 / $389.19 / $568.78
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$88.59 / $114.65 / $174.85
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$208.49 / $274.52 / $393.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.60 / $565.48 / $943.28
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.57 / $135.38 / $189.34
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$258.64 / $383.52 / $776.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.24 / $413.87 / $782.46
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.29 / $125.50 / $226.39
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$234.95 / $282.73 / $510.03
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$97.17 / $97.17 / $167.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.24 / $494.18 / $711.52
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$93.70 / $145.76 / $186.62
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$232.54 / $358.03 / $433.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.83 / $441.59 / $783.28
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$88.06 / $128.01 / $224.72
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$224.11 / $327.63 / $558.55