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Pennsylvania rates for HCPCS 70486

Ct Maxillofacial W/O Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$40.61 / $56.81 / $108.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.87 / $253.19 / $805.77
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.86 / $55.97 / $160.62
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$60.63 / $70.09 / $137.50
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$84.55 / $168.00 / $308.42
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.76 / $96.87 / $123.49
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.75 / $44.86 / $66.95
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$116.96 / $132.91 / $132.91
AmeriHealth
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.10 / $54.58 / $642.48
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.97 / $212.48 / $525.86
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.42 / $67.97 / $131.86
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$93.57 / $144.15 / $394.00
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
$118.95 / $240.44 / $419.46
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.77 / $57.99 / $94.56
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$80.66 / $164.54 / $318.47
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.94 / $201.50 / $631.44
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.46 / $53.40 / $84.17
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$102.31 / $127.41 / $181.50
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.71 / $152.30 / $278.43
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.01 / $51.59 / $75.55
Highmark BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$133.62 / $159.40 / $160.34
Independence Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.24 / $132.24 / $132.24
Independence Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.45 / $51.78 / $101.01
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$40.61 / $56.09 / $141.06
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.87 / $233.14 / $730.29
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.15 / $56.55 / $145.00
Martin's Point
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$60.63 / $75.62 / $169.27
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$85.19 / $131.69 / $316.57
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.33 / $120.82 / $325.00
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$37.25 / $46.27 / $46.27
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.40 / $235.00 / $409.55
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.49 / $57.96 / $96.61
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.86 / $164.50 / $316.54
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$40.15 / $40.15 / $66.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.79 / $127.72 / $264.50
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.15 / $40.15 / $66.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$85.66 / $87.57 / $198.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.09 / $174.90 / $311.45
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.90 / $51.37 / $83.16
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$82.18 / $113.22 / $218.88