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Maine rates for HCPCS 73201

Ct Upper Extremity W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$66.23 / $66.23 / $66.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.66 / $272.22 / $335.06
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.07 / $56.11 / $83.57
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$164.55 / $222.12 / $276.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.37 / $282.60 / $420.19
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.78 / $73.98 / $112.65
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$160.50 / $207.90 / $307.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.45 / $359.17 / $580.36
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$55.30 / $87.91 / $122.42
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$197.19 / $269.20 / $428.16
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.62 / $301.58 / $544.04
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$67.19 / $80.84 / $145.86
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$183.43 / $219.77 / $423.08
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.39 / $293.48 / $431.13
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.81 / $66.23 / $120.61
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$181.61 / $230.79 / $310.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.82 / $313.05 / $526.95
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$58.61 / $83.06 / $136.66
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$166.73 / $219.56 / $415.68