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New Hampshire rates for HCPCS 70487

Ct Maxillofacial W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$59.07 / $91.48 / $240.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.30 / $293.12 / $892.76
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.91 / $59.08 / $165.38
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$90.39 / $240.16 / $727.35
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.73 / $363.65 / $363.65
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.11 / $66.20 / $170.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.76 / $319.98 / $458.81
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.43 / $109.88 / $155.38
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$98.33 / $210.09 / $297.10
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$76.91 / $76.91 / $76.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.30 / $356.03 / $651.48
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.88 / $109.37 / $160.52
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$132.07 / $238.06 / $513.15
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.45 / $304.70 / $564.77
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$58.88 / $104.64 / $193.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$112.57 / $200.06 / $370.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.89 / $254.43 / $460.45
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$59.77 / $75.06 / $151.97
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$124.52 / $167.82 / $307.67
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.18 / $183.26 / $301.88
Well Sense
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.37 / $53.78 / $75.33
Well Sense
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$89.80 / $107.76 / $242.99