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Maine rates for HCPCS 76497

Unlisted computed tomography procedure (eg, diagnostic, interventional)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $891.25 / $2,187.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $114.82 / $371.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $109.65 / $109.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $169.82 / $588.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $891.25 / $891.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $123.03 / $602.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $446.68