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Maine rates for HCPCS 75561

Cardiac Mri W/Wo Contrast & Further Seq

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
$399.88 / $475.00 / $612.66
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$124.72 / $145.65 / $227.68
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$275.16 / $335.00 / $433.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.19 / $529.44 / $758.14
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$117.74 / $163.35 / $251.56
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$268.08 / $364.06 / $506.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$503.98 / $713.08 / $1,150.00
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$129.62 / $192.03 / $273.86
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$345.88 / $508.58 / $806.31
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.18 / $530.50 / $981.59
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$150.04 / $176.03 / $325.70
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$302.14 / $363.59 / $655.89
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.00 / $597.91 / $780.77
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$127.50 / $167.00 / $269.20
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$297.50 / $385.24 / $511.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.64 / $576.20 / $993.00
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$126.19 / $182.83 / $302.80
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$296.30 / $414.82 / $691.64