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Oklahoma rates for HCPCS 71250

Diagnostic Computed Tomography Thorax W/O Cntrst

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$46.73 / $67.31 / $74.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.88 / $171.00 / $227.43
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.97 / $54.53 / $68.84
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$66.95 / $82.31 / $88.10
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$81.87 / $104.98 / $177.61
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.27 / $120.38 / $134.79
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.99 / $47.49 / $64.11
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$94.76 / $94.76 / $151.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.24 / $133.35 / $183.11
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$53.34 / $53.34 / $85.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.57 / $200.04 / $320.33
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.90 / $54.32 / $83.70
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$69.98 / $143.75 / $246.52
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
$137.54 / $203.96 / $1,609.32
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.03 / $62.79 / $394.61
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$88.22 / $152.11 / $1,384.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.72 / $176.66 / $308.37
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.03 / $59.19 / $88.09
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$88.22 / $113.04 / $210.11