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Maine rates for HCPCS 73220

Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$141.25 / $141.25 / $165.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $501.19 / $1,348.96
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.71 / $158.49 / $331.13
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$281.84 / $436.52 / $758.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $602.56 / $1,513.56
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.00 / $144.54 / $331.13
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$309.03 / $457.09 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $891.25 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.33 / $138.04 / $288.40
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$389.05 / $691.83 / $1,318.26
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $616.60 / $1,230.27
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$120.23 / $151.36 / $281.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$371.54 / $467.74 / $933.25
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$141.25 / $141.25 / $141.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $602.56 / $1,348.96
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$112.20 / $165.96 / $323.59
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$302.00 / $478.63 / $977.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $707.95 / $1,348.96
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.15 / $151.36 / $281.84
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$338.84 / $524.81 / $1,071.52