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New Jersey rates for HCPCS 71250

Computed tomography, thorax, diagnostic; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$46.77 / $69.18 / $316.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $208.93 / $831.76
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.71 / $54.95 / $162.18
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$79.43 / $128.82 / $389.05
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $117.49 / $208.93
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.90 / $46.77 / $93.33
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$34.67 / $74.13 / $109.65
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $141.25 / $549.54
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$38.02 / $38.02 / $38.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $257.04 / $446.68
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.15 / $67.61 / $114.82
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$81.28 / $181.97 / $331.13
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $186.21 / $562.34
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.54 / $67.61 / $562.34
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$100.00 / $120.23 / $562.34
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $162.18 / $338.84
Horizon BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $56.23 / $91.20
Horizon BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$89.13 / $109.65 / $208.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $213.80 / $363.08
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$40.74 / $61.66 / $104.71
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$70.79 / $134.90 / $251.19