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Utah rates for HCPCS 70487

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

Facilitymedian $331 · 10th–90th $71$3310%50%10th$331Professionalmedian $132 · 10th–90th $55$3390%5%10%10th90th$132$50.0$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$70.79 / $331.13 / $331.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $288.40 / $933.25
Aetna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$51.29 / $87.10 / $218.78
Aetna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$100.00 / $218.78 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $275.42 / $436.52
Cigna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$50.12 / $72.44 / $117.49
Cigna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$95.50 / $204.17 / $323.59
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $239.88
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$323.59 / $323.59 / $323.59
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $257.04 / $524.81
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$74.13 / $87.10 / $144.54
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$144.54 / $169.82 / $380.19
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $234.42 / $354.81
Select Health
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$51.29 / $109.65 / $169.82
Select Health
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$93.33 / $125.89 / $199.53
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $158.49 / $288.40
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $239.88 / $398.11
United
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$48.98 / $54.95 / $104.71
United
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$95.50 / $158.49 / $323.59