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Texas rates for HCPCS 70487

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$43.65 / $53.70 / $70.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $213.80 / $524.81
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $74.13 / $213.80
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.50 / $138.04 / $309.03
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $144.54 / $181.97
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$40.74 / $51.29 / $97.72
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$131.83 / $131.83 / $131.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $120.23 / $177.83
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $213.80 / $288.40
Christus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.12 / $51.29 / $53.70
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
$134.90 / $251.19 / $501.19
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.67 / $70.79 / $128.82
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$89.13 / $173.78 / $346.74
Lucent Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$489.78 / $489.78 / $489.78
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $1,698.24
Lucent Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$389.05 / $426.58 / $426.58
Lucent Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$2,041.74 / $2,041.74 / $2,041.74
Moda Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$43.65 / $53.70 / $70.79
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $269.15 / $537.03
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $75.86 / $181.97
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$100.00 / $154.88 / $346.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $125.89
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $158.49 / $575.44
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$13.18 / $60.26 / $87.10
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $257.04 / $457.09
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.67 / $66.07 / $112.20
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$89.13 / $165.96 / $346.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $218.78 / $389.05
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.98 / $57.54 / $107.15
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.50 / $147.91 / $275.42
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $144.54 / $181.97
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $53.70 / $63.10
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.50 / $95.50 / $117.49