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Maine rates for HCPCS 74420

Urography, retrograde, with or without KUB

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$28.84 / $28.84 / $28.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $107.15 / $338.84
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$15.85 / $28.84 / $53.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $112.20 / $426.58
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$15.85 / $31.62 / $45.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $128.82 / $223.87
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$17.78 / $31.62 / $60.26
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $123.03 / $245.47
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.20 / $37.15 / $69.18
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $114.82 / $275.42
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.60 / $30.20 / $57.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $147.91 / $512.86
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$22.39 / $30.90 / $53.70