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CT Scan Of The Face And Jaw, Without Contrast

South Dakota rates for HCPCS 70486

This is a CT scan of the maxillofacial area, which includes the bones and soft tissue of the face, jaw, and sinuses, performed without contrast dye. It's used to evaluate injuries, infections, sinus disease, or structural problems in this region. Cross-sectional images give a more detailed view than a standard X-ray.

Rates data updated July 2026.

Facilitymedian $30 · 10th–90th $30$300%50%100%$30Professionalmedian $72 · 10th–90th $39$3090%20%10th90th$72$50.0$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
26 · Professional part
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$239.88
Typical High
$2,454.71
Aetna
Setting
Professional
Modifier
26 · Professional part
Typical Low
$38.02
Median
$39.81
Typical High
$154.88
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$60.26
Median
$69.18
Typical High
$223.87
Aetna
Setting
Professional
Modifier
TC · Technical part
Typical Low
$97.72
Median
$436.52
Typical High
$1,445.44
Avera
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$218.78
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$316.23
Typical High
$389.05
Cigna
Setting
Professional
Modifier
26 · Professional part
Typical Low
$75.86
Median
$95.50
Typical High
$117.49
Cigna
Setting
Professional
Modifier
TC · Technical part
Typical Low
$173.78
Median
$218.78
Typical High
$275.42
Medica
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$239.88
Typical High
$1,412.54
Medica
Setting
Professional
Modifier
26 · Professional part
Typical Low
$46.77
Median
$77.62
Typical High
$199.53
Medica
Setting
Professional
Modifier
TC · Technical part
Typical Low
$97.72
Median
$165.96
Typical High
$1,230.27
Midlands
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$275.42
Typical High
$309.03
Midlands
Setting
Professional
Modifier
26 · Professional part
Typical Low
$81.28
Median
$87.10
Typical High
$100.00
Midlands
Setting
Professional
Modifier
TC · Technical part
Typical Low
$177.83
Median
$190.55
Typical High
$208.93
Midlands
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$288.40
Midlands
Setting
Professional
Modifier
26 · Professional part
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
Midlands
Setting
Professional
Modifier
TC · Technical part
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$229.09
Typical High
$380.19
Sanford Health Plan
Setting
Professional
Modifier
26 · Professional part
Typical Low
$50.12
Median
$72.44
Typical High
$77.62
Sanford Health Plan
Setting
Professional
Modifier
TC · Technical part
Typical Low
$117.49
Median
$162.18
Typical High
$302.00
United
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$257.04
Typical High
$346.74
United
Setting
Professional
Modifier
26 · Professional part
Typical Low
$46.77
Median
$77.62
Typical High
$107.15
United
Setting
Professional
Modifier
TC · Technical part
Typical Low
$97.72
Median
$177.83
Typical High
$257.04
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$281.84
Typical High
$288.40
Wellmark
Setting
Professional
Modifier
26 · Professional part
Typical Low
$77.62
Median
$87.10
Typical High
$89.13
Wellmark
Setting
Professional
Modifier
TC · Technical part
Typical Low
$173.78
Median
$194.98
Typical High
$199.53