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Michigan rates for HCPCS 70488

Ct Maxillofacial W/O & W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$77.73 / $77.73 / $97.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.54 / $236.40 / $608.04
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.69 / $77.73 / $93.15
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$122.85 / $158.66 / $473.68
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.40 / $147.40 / $147.40
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.09 / $55.96 / $70.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.64 / $223.10 / $376.47
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$94.80 / $94.80 / $94.80
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$68.70 / $68.70 / $68.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.76 / $354.90 / $664.52
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.70 / $80.79 / $148.37
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$131.72 / $228.41 / $454.50
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$55.32 / $55.32 / $97.93
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.99 / $285.76 / $457.33
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$55.32 / $71.18 / $113.23
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$135.28 / $230.44 / $380.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.58 / $140.30 / $200.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.07 / $284.01 / $422.21
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$60.96 / $72.67 / $104.22
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$136.97 / $253.65 / $352.73