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Maine rates for HCPCS 74400

Urography (pyelography), intravenous, with or without KUB, with or without tomography

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $138.04 / $302.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$18.20 / $22.91 / $52.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $169.82 / $251.19
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.38 / $29.51 / $43.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $177.83 / $302.00
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.44 / $33.88 / $57.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $208.93 / $398.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$27.54 / $34.67 / $64.57
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $144.54 / $371.54
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.95 / $26.92 / $74.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $165.96 / $331.13
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.99 / $34.67 / $61.66