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Maine rates for HCPCS 76120

Cineradiography/videoradiography, except where specifically included

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.92 / $77.95 / $123.73
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$14.57 / $18.53 / $21.43
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$50.35 / $60.10 / $104.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.89 / $152.66 / $225.09
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$18.11 / $25.77 / $36.22
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$88.31 / $120.28 / $173.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.06 / $150.54 / $273.63
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$18.16 / $30.05 / $44.02
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$51.90 / $125.81 / $229.61
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.61 / $163.19 / $294.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.08 / $27.78 / $50.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$112.53 / $135.41 / $244.28
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.37 / $84.56 / $181.26
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$14.66 / $18.53 / $32.26
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$53.07 / $101.93 / $149.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.37 / $132.52 / $256.80
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.48 / $27.55 / $44.60
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$79.73 / $94.50 / $212.20