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Maine rates for HCPCS 70486

Computed tomography, maxillofacial area; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$46.77 / $50.12 / $295.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $234.42 / $512.86
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.02 / $54.95 / $158.49
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$89.13 / $141.25 / $407.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $186.21 / $426.58
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.81 / $57.54 / $131.83
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$89.13 / $128.82 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $263.03 / $501.19
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.65 / $64.57 / $117.49
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.72 / $181.97 / $380.19
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $194.98 / $380.19
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.86 / $60.26 / $112.20
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$107.15 / $134.90 / $263.03
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$46.77 / $48.98 / $295.12
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $229.09 / $478.63
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.81 / $58.88 / $128.82
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$100.00 / $147.91 / $323.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $199.53 / $436.52
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.66 / $61.66 / $112.20
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$89.13 / $134.90 / $275.42