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Maine rates for HCPCS 74176

Ct Abdomen & Pelvis W/O Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$99.54 / $99.54 / $589.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.50 / $219.05 / $308.56
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$72.87 / $86.66 / $133.79
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$117.43 / $128.99 / $181.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.46 / $254.25 / $386.32
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$86.24 / $111.60 / $169.32
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$110.22 / $142.63 / $217.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.25 / $296.08 / $429.14
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$88.35 / $130.84 / $184.75
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$134.01 / $174.28 / $244.39
Community Health Options
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.00 / $371.00 / $397.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.42 / $266.60 / $500.20
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.99 / $123.21 / $232.93
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$129.43 / $155.07 / $298.52
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$99.54 / $114.85 / $589.96
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.22 / $228.53 / $400.14
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.20 / $99.54 / $172.28
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$120.95 / $136.56 / $218.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.65 / $301.74 / $503.55
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.96 / $124.64 / $205.39
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$114.04 / $159.52 / $266.13