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Maine rates for HCPCS 76873

Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $190.55 / $302.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$61.66 / $77.62 / $162.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $208.93 / $338.84
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$69.18 / $91.20 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $239.88 / $398.11
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.79 / $107.15 / $169.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $281.84 / $512.86
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$91.20 / $123.03 / $218.78
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $199.53 / $371.54
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.07 / $89.13 / $186.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $239.88 / $457.09
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$72.44 / $112.20 / $204.17