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Missouri rates for HCPCS 70486

Computed tomography, maxillofacial area; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$43.36 / $50.10 / $85.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.18 / $258.32 / $784.76
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.46 / $57.37 / $199.43
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$64.88 / $80.45 / $137.50
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$96.81 / $195.98 / $548.41
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.47 / $96.87 / $215.14
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.12 / $42.31 / $57.75
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$74.78 / $74.78 / $74.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.40 / $170.02 / $449.79
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.38 / $55.86 / $118.33
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$84.02 / $116.80 / $335.62
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
$111.28 / $216.12 / $440.19
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.44 / $60.61 / $106.30
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$78.39 / $157.50 / $333.56
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$295.27 / $379.28 / $379.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.47 / $268.00 / $1,413.47
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.03 / $65.63 / $333.52
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$96.93 / $189.10 / $1,220.00
Qualchoice
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$73.75 / $73.75 / $73.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.10 / $202.67 / $356.52
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.63 / $54.22 / $89.44
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$93.35 / $126.59 / $249.90