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Maine rates for HCPCS 70486

Ct Maxillofacial W/O Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$46.58 / $49.09 / $55.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.63 / $226.80 / $272.68
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.22 / $51.79 / $69.70
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$69.89 / $79.64 / $118.17
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$101.43 / $177.61 / $211.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.31 / $176.40 / $269.52
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.25 / $54.82 / $83.62
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$93.89 / $121.50 / $185.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.66 / $253.65 / $443.72
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.84 / $66.17 / $108.66
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$115.25 / $175.97 / $325.49
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.76 / $193.45 / $348.98
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.88 / $60.02 / $108.28
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$110.88 / $133.43 / $240.70
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$46.58 / $49.09 / $298.17
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.81 / $216.71 / $278.51
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.58 / $54.70 / $92.91
Martin's Point
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$69.89 / $79.64 / $118.17
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$105.52 / $146.82 / $217.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.47 / $228.83 / $342.96
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.38 / $61.05 / $108.17
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$88.58 / $131.96 / $240.70