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Utah rates for HCPCS 70487

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$70.79 / $331.13 / $331.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $288.40 / $933.25
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $104.71 / $213.80
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.50 / $154.88 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $275.42 / $436.52
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.86 / $70.79 / $117.49
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.50 / $204.17 / $323.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $239.88
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$323.59 / $323.59 / $323.59
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $295.12 / $524.81
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.13 / $97.72 / $144.54
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$144.54 / $194.98 / $380.19
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $234.42 / $331.13
Select Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $109.65 / $131.83
Select Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$93.33 / $125.89 / $199.53
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $162.18 / $302.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $234.42 / $398.11
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.98 / $54.95 / $104.71
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.50 / $158.49 / $269.15