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Illinois rates for HCPCS 71250

Diagnostic Computed Tomography Thorax W/O Cntrst

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$54.53 / $82.98 / $100.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.88 / $226.08 / $687.35
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.24 / $66.06 / $228.65
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$66.72 / $81.52 / $133.28
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$82.42 / $156.07 / $278.57
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.28 / $120.10 / $159.46
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.46 / $48.62 / $71.63
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$65.77 / $87.73 / $101.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.26 / $157.71 / $302.33
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$62.76 / $62.76 / $62.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.04 / $216.62 / $426.90
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.79 / $69.31 / $104.80
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.01 / $140.00 / $303.75
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.33 / $243.70 / $1,315.07
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$61.62 / $87.61 / $339.04
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.36 / $149.58 / $861.26
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
$160.50 / $163.36 / $176.01
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$61.80 / $63.27 / $66.76
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.23 / $101.56 / $109.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $69.84 / $184.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.03 / $244.75 / $399.61
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.61 / $68.06 / $110.25
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$100.40 / $165.50 / $283.86