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Wisconsin rates for HCPCS 70487

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

Facilitymedian $120 · 10th–90th $105$4900%50%10th90th$120Professionalmedian $155 · 10th–90th $59$4900%5%10th90th$155$10.0$50.0$200.0$1.0K

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
$104.71 / $120.23 / $120.23
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $269.15 / $524.81
Aetna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$52.48 / $104.71 / $251.19
Aetna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$100.00 / $158.49 / $302.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $281.84 / $891.25
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$52.48 / $83.18 / $302.00
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$100.00 / $204.17 / $588.84
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $120.23 / $190.55
Cigna
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$141.25 / $162.18 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $457.09 / $630.96
Cigna
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$58.88 / $125.89 / $213.80
Cigna
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$138.04 / $295.12 / $416.87
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $338.84 / $467.74
DeanCare
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$97.72 / $117.49 / $158.49
DeanCare
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$186.21 / $223.87 / $302.00
Medica
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$501.19 / $501.19 / $501.19
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $398.11 / $1,698.24
Medica
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$63.10 / $128.82 / $389.05
Medica
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$125.89 / $281.84 / $2,041.74
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $316.23
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $467.74 / $758.58
Network Health
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$75.86 / $125.89 / $199.53
Network Health
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$151.36 / $316.23 / $562.34
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $380.19 / $1,000.00
Quartz
Facility/Professional
Facility
Modifier
26
Typical Low / Median / Typical High
$123.03 / $489.78 / $489.78
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $977.24 / $1,698.24
Quartz
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$77.62 / $281.84 / $389.05
Quartz
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$144.54 / $758.58 / $2,041.74
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $407.38
Security Health
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$141.25 / $141.25 / $141.25
Security Health
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$269.15 / $269.15 / $269.15
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $912.01 / $1,318.26
Security Health
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$186.21 / $213.80 / $323.59
Security Health
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$354.81 / $426.58 / $645.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $549.54 / $1,202.26
United
Facility/Professional
Professional
Modifier
26
Typical Low / Median / Typical High
$87.10 / $194.98 / $407.38
United
Facility/Professional
Professional
Modifier
TC
Typical Low / Median / Typical High
$112.20 / $239.88 / $457.09