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Pennsylvania rates for HCPCS 70487

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$51.29 / $107.15 / $213.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $263.03 / $933.25
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.48 / $97.72 / $223.87
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$100.00 / $169.82 / $436.52
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $123.03 / $123.03
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.66 / $57.54 / $89.13
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $199.53 / $398.11
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.70 / $69.18 / $141.25
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.72 / $128.82 / $363.08
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$13.18 / $60.26 / $87.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $281.84 / $489.78
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$40.74 / $72.44 / $123.03
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.50 / $190.55 / $380.19
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $204.17 / $257.04
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.48 / $69.18 / $85.11
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$107.15 / $134.90 / $173.78
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $234.42 / $478.63
Geisinger
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $69.18 / $128.82
Geisinger
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$100.00 / $165.96 / $346.74
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $194.98 / $204.17
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$58.88 / $67.61 / $100.00
Highmark BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$186.21 / $186.21 / $302.00
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$53.70 / $95.50 / $213.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $269.15 / $549.54
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.48 / $81.28 / $181.97
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$102.33 / $173.78 / $398.11
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $323.59 / $467.74
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$53.70 / $53.70 / $70.79
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $177.83 / $338.84
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $53.70 / $70.79
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.50 / $97.72 / $275.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $218.78 / $371.54
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $60.26 / $100.00
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$93.33 / $134.90 / $269.15