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Illinois rates for HCPCS 71250

Computed tomography, thorax, diagnostic; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$53.70 / $77.62 / $186.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $245.47 / $851.14
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $58.88 / $190.55
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$69.18 / $144.54 / $346.74
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$79.43 / $128.82 / $371.54
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $104.71 / $151.36
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.02 / $48.98 / $79.43
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$61.66 / $79.43 / $123.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $158.49 / $302.00
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$63.10 / $63.10 / $63.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $218.78 / $426.58
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.66 / $69.18 / $102.33
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.18 / $147.91 / $309.03
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $371.54 / $1,819.70
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$60.26 / $104.71 / $467.74
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.72 / $239.88 / $1,479.11
Hally Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $162.18 / $177.83
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$61.66 / $63.10 / $66.07
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.72 / $102.33 / $109.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $239.88 / $398.11
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $66.07 / $107.15
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.50 / $165.96 / $302.00