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Arizona rates for HCPCS 70487

Computed tomography, maxillofacial area; with contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$74.50 / $103.24 / $215.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.00 / $287.22 / $519.15
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.42 / $64.59 / $212.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$116.69 / $220.28 / $349.82
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.33 / $134.93 / $366.94
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$40.69 / $61.64 / $98.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.40 / $174.17 / $217.71
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.47 / $53.11 / $66.39
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$105.92 / $121.06 / $151.32
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$60.98 / $60.98 / $60.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.21 / $281.25 / $468.76
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.53 / $71.09 / $118.16
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$85.38 / $204.44 / $344.36
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$498.88 / $498.88 / $498.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.18 / $281.19 / $1,708.01
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.08 / $57.74 / $384.71
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.10 / $228.05 / $2,023.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.18 / $246.90 / $364.68
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.99 / $56.72 / $118.79
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.10 / $202.81 / $266.38