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Michigan rates for HCPCS 70486

Computed tomography, maxillofacial area; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$52.17 / $52.17 / $61.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.63 / $226.80 / $471.90
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.90 / $54.78 / $152.13
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$64.16 / $81.70 / $113.40
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$102.54 / $166.86 / $291.63
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.02 / $102.60 / $126.85
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.61 / $41.80 / $63.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.25 / $165.08 / $242.76
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.77 / $64.44 / $64.44
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$143.27 / $143.27 / $143.27
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.32 / $103.10 / $166.03
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$46.27 / $46.27 / $46.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.49 / $245.52 / $459.95
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.77 / $61.00 / $107.16
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$91.65 / $158.88 / $306.01
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$44.13 / $52.17 / $54.78
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.81 / $196.23 / $383.41
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.41 / $54.21 / $142.35
Health Alliance Plan
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$78.42 / $81.70 / $185.50
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$104.64 / $152.11 / $245.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.95 / $108.90 / $159.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.40 / $205.74 / $285.98
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.51 / $52.53 / $70.69
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$91.29 / $159.80 / $227.28