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Maine rates for HCPCS 76100

Radiologic examination, single plane body section (eg, tomography), other than with urography

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.77 / $106.73 / $117.41
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$47.56 / $75.59 / $86.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.96 / $122.88 / $170.40
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$59.54 / $84.96 / $118.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.53 / $133.96 / $211.27
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$60.86 / $86.80 / $146.66
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.82 / $130.94 / $236.23
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$75.02 / $90.28 / $162.85
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.44 / $110.16 / $155.77
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$65.91 / $77.54 / $113.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.66 / $138.51 / $245.66
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$67.48 / $89.25 / $157.35