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New Hampshire rates for HCPCS 70488

Ct Maxillofacial W/O & W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$89.70 / $260.27 / $260.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.47 / $349.43 / $1,087.48
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.93 / $64.00 / $179.89
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$114.55 / $288.44 / $907.58
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 / $46.09 / $46.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.14 / $387.02 / $554.94
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.58 / $123.02 / $173.97
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$123.56 / $264.00 / $373.34
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$84.53 / $84.53 / $84.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.08 / $432.83 / $800.00
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$73.68 / $123.00 / $179.71
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$166.99 / $303.07 / $640.88
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.37 / $358.71 / $683.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.91 / $114.01 / $217.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$141.44 / $250.85 / $465.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.08 / $310.19 / $559.29
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.81 / $83.98 / $171.75
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$156.47 / $214.26 / $433.59
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.63 / $223.79 / $367.84
Well Sense
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.78 / $60.49 / $81.69
Well Sense
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$113.86 / $136.63 / $303.50