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California rates for HCPCS 71250

Diagnostic Computed Tomography Thorax W/O Cntrst

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$46.90 / $58.79 / $336.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.86 / $247.93 / $802.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.92 / $61.74 / $210.08
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$67.23 / $109.05 / $456.88
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$91.32 / $202.05 / $504.92
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.26 / $135.12 / $296.88
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.69 / $61.42 / $115.15
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$61.68 / $75.89 / $110.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.69 / $322.29 / $576.55
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.89 / $74.75 / $145.29
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$111.90 / $247.86 / $441.57
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.94 / $206.80 / $512.98
Blue Shield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.40 / $62.56 / $151.66
Blue Shield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$100.00 / $145.32 / $366.10
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$58.64 / $58.64 / $58.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.25 / $264.92 / $499.33
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.26 / $64.34 / $138.78
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$84.14 / $183.91 / $370.85
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.32 / $172.44 / $232.79
Contra Costa Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.38 / $56.63 / $76.45
Contra Costa Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$92.94 / $115.81 / $156.34
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.12 / $175.97 / $292.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.12 / $67.95 / $118.70
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$89.28 / $133.91 / $217.14
Lucent Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$466.96 / $466.96 / $479.84
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,609.32 / $1,657.60 / $1,657.60
Lucent Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$394.61 / $394.61 / $409.43
Lucent Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,384.00 / $1,384.00 / $1,384.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $101.49
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$58.64 / $58.64 / $58.64
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.11 / $284.19 / $450.12
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$29.76 / $62.71 / $136.57
Providence
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$157.38 / $157.38 / $159.13
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$84.14 / $186.54 / $359.30
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.79 / $525.79 / $525.79
Sutter Health Plus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$188.55 / $188.55 / $188.55
Sutter Health Plus
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$337.24 / $337.24 / $337.24
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.46 / $191.75 / $567.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.51 / $205.33 / $455.23
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.54 / $59.19 / $140.16
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$86.20 / $148.22 / $333.48