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New Hampshire rates for HCPCS 71250

Diagnostic Computed Tomography Thorax W/O Cntrst

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$46.49 / $81.45 / $213.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.46 / $231.03 / $689.27
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.79 / $46.49 / $130.38
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$67.73 / $84.39 / $160.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.67 / $184.55 / $558.89
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.01 / $107.20 / $317.87
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.88 / $56.82 / $162.50
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$67.66 / $67.66 / $67.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.00 / $279.89 / $405.85
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.17 / $105.05 / $148.56
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$81.84 / $174.85 / $250.71
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$68.83 / $68.83 / $68.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.31 / $311.91 / $607.34
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$62.95 / $104.53 / $151.91
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$114.34 / $197.61 / $475.59
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.97 / $259.42 / $494.02
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.29 / $97.37 / $185.42
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$93.69 / $166.15 / $308.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.55 / $239.92 / $491.61
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.89 / $76.54 / $136.94
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$126.78 / $153.19 / $610.17
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.86 / $173.18 / $249.49
Well Sense
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.14 / $52.91 / $66.87
Well Sense
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$62.29 / $74.75 / $84.09
Well Sense
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$81.40 / $100.94 / $196.79