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Maine rates for HCPCS 73701

Computed tomography, lower extremity; with contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$66.07 / $66.07 / $66.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $223.87 / $524.81
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.12 / $67.61 / $181.97
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$120.23 / $173.78 / $309.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $245.47 / $616.60
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.70 / $77.62 / $181.97
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$112.20 / $165.96 / $426.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $331.13 / $588.84
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.23 / $79.43 / $154.88
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$147.91 / $245.47 / $446.68
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $251.19 / $501.19
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.57 / $81.28 / $151.36
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$134.90 / $173.78 / $338.84
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $275.42 / $602.56
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.95 / $83.18 / $177.83
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$138.04 / $199.53 / $416.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $309.03 / $549.54
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.54 / $83.18 / $151.36
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$125.89 / $223.87 / $389.05