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Washington rates for HCPCS 70487

Ct Maxillofacial W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$60.03 / $94.26 / $155.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.26 / $297.81 / $519.15
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$55.00 / $78.56 / $161.81
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$121.66 / $231.15 / $414.48
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.12 / $254.12 / $254.12
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.12 / $85.64 / $93.42
Asuris Northwest Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$498.88 / $498.88 / $498.88
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.06 / $392.04 / $1,708.01
Asuris Northwest Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$73.00 / $132.80 / $438.75
Asuris Northwest Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$145.07 / $261.86 / $2,023.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.35 / $335.12 / $565.01
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.15 / $98.97 / $173.77
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$110.70 / $227.00 / $404.73
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$59.13 / $122.44 / $539.79
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.43 / $384.97 / $749.02
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.04 / $119.28 / $159.47
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$134.53 / $264.14 / $599.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.46 / $149.27 / $312.59
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$86.90 / $104.95 / $113.28
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$67.62 / $96.60 / $122.10
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$131.04 / $232.44 / $370.44
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$71.56 / $71.56 / $72.20
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.32 / $368.50 / $449.25
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$82.19 / $124.01 / $148.09
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$160.84 / $244.09 / $302.33
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$346.39 / $346.39 / $851.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.06 / $323.86 / $444.48
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$73.00 / $109.34 / $148.27
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$145.07 / $214.52 / $295.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.18 / $281.19 / $462.95
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.08 / $69.65 / $155.84
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.10 / $195.79 / $328.85
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.41 / $175.41 / $175.41
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$55.68 / $55.68 / $55.68
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$119.73 / $119.73 / $119.73