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Missouri rates for HCPCS 71250

Computed tomography, thorax, diagnostic; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$47.35 / $63.36 / $108.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.97 / $221.75 / $833.70
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.88 / $58.94 / $201.04
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$69.06 / $83.68 / $140.38
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$86.32 / $177.61 / $586.08
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.42 / $100.87 / $116.89
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.88 / $52.01 / $76.17
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$70.33 / $70.33 / $151.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.13 / $191.88 / $492.35
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.68 / $69.70 / $120.51
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$87.44 / $122.30 / $349.04
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
$115.94 / $226.32 / $450.00
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.57 / $70.76 / $127.24
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$73.52 / $152.13 / $340.70
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$371.04 / $479.84 / $479.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.13 / $278.95 / $1,609.32
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$55.01 / $76.95 / $394.61
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$101.12 / $198.54 / $1,384.00
Qualchoice
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$92.75 / $92.75 / $92.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.78 / $224.84 / $383.89
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.27 / $68.70 / $129.49
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$91.27 / $141.97 / $260.06