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Maine rates for HCPCS 75561

Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences;

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$165.96 / $165.96 / $165.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $478.63 / $2,290.87
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$114.82 / $190.55 / $416.87
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$257.04 / $338.84 / $660.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $524.81 / $1,258.93
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$117.49 / $169.82 / $398.11
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$245.47 / $354.81 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $776.25 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$123.03 / $165.96 / $346.74
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$302.00 / $562.34 / $1,000.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $562.34 / $1,096.48
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$144.54 / $181.97 / $346.74
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$295.12 / $371.54 / $741.31
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $602.56 / $1,318.26
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$123.03 / $190.55 / $416.87
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$269.15 / $416.87 / $870.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $602.56 / $1,148.15
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$125.89 / $181.97 / $331.13
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$269.15 / $407.38 / $794.33