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Maine rates for HCPCS 73723

Mri Any Jt Lower Extrem W/O & W/Contrast 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
$425.00 / $475.00 / $697.67
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$111.15 / $140.00 / $167.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$297.50 / $335.00 / $542.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.17 / $561.86 / $806.51
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$106.06 / $137.25 / $210.79
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$317.73 / $423.91 / $595.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$534.49 / $824.77 / $1,251.86
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.99 / $160.97 / $228.03
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$402.13 / $592.20 / $1,123.59
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.04 / $578.86 / $1,044.24
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$125.72 / $151.29 / $272.91
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$355.32 / $427.58 / $771.33
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$462.17 / $600.00 / $1,040.40
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$125.78 / $166.42 / $250.85
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$335.00 / $433.00 / $786.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.08 / $667.38 / $1,139.80
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$108.67 / $153.74 / $253.37
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$317.07 / $483.94 / $869.21