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Maine rates for HCPCS 72156

Mri Spinal Canal Cervical W/O & W/Contr 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 / $145.65 / $177.84
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
$355.45 / $459.99 / $673.13
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$113.01 / $146.25 / $224.61
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$237.40 / $312.89 / $448.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.78 / $668.30 / $1,267.63
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$117.65 / $176.81 / $244.71
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$295.73 / $453.96 / $1,120.83
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$401.48 / $483.13 / $871.53
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$133.97 / $161.21 / $290.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$267.52 / $321.92 / $580.73
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.17 / $546.25 / $851.45
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$120.31 / $167.00 / $264.06
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$258.39 / $381.77 / $574.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.51 / $569.52 / $927.55
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$117.29 / $178.01 / $270.49
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$233.00 / $374.77 / $598.04