go back

Maine rates for HCPCS 72149

Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$97.72 / $165.96 / $165.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $446.68 / $1,047.13
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.11 / $120.23 / $269.15
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$208.93 / $302.00 / $660.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $398.11 / $1,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.28 / $123.03 / $275.42
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$186.21 / $275.42 / $707.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $630.96 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.11 / $123.03 / $239.88
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$229.09 / $501.19 / $831.76
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $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 / $288.40 / $562.34
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$97.72 / $97.72 / $165.96
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $549.54 / $1,096.48
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.71 / $147.91 / $269.15
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$239.88 / $371.54 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $446.68 / $933.25
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.10 / $125.89 / $229.09
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$204.17 / $316.23 / $645.65