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Pennsylvania rates for HCPCS 70487

Ct Maxillofacial W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$53.50 / $67.45 / $174.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.87 / $204.38 / $519.15
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.96 / $69.08 / $193.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$96.31 / $125.29 / $301.27
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.33 / $80.73 / $92.27
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.11 / $55.11 / $87.95
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.99 / $248.54 / $474.62
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.36 / $86.98 / $151.61
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$96.62 / $161.57 / $359.29
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
$141.50 / $287.64 / $500.31
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$40.36 / $69.73 / $113.96
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$91.15 / $188.39 / $390.06
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.20 / $238.83 / $762.13
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$58.39 / $70.13 / $110.70
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$115.67 / $143.94 / $205.00
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.55 / $193.11 / $193.45
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$59.27 / $75.11 / $103.39
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$53.50 / $76.01 / $175.54
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.87 / $213.66 / $612.39
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.96 / $78.42 / $175.21
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$96.92 / $132.16 / $431.50
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.40 / $153.51 / $325.00
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$42.78 / $60.98 / $60.98
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.50 / $283.77 / $491.99
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.53 / $70.76 / $113.96
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$91.15 / $180.97 / $380.10
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$53.10 / $53.10 / $71.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.60 / $151.72 / $347.50
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.73 / $53.12 / $71.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$96.48 / $98.64 / $276.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.40 / $211.94 / $379.68
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.05 / $65.23 / $106.22
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$94.35 / $136.19 / $265.70