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Arizona rates for HCPCS 72126

Computed tomography, cervical spine; with contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$81.01 / $111.08 / $233.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.00 / $282.06 / $510.94
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.30 / $61.58 / $158.22
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$119.70 / $220.00 / $377.04
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.50 / $149.50 / $149.50
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.54 / $76.61 / $106.12
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$59.28 / $59.28 / $59.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.17 / $193.34 / $241.67
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.00 / $57.14 / $71.43
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$119.17 / $136.19 / $170.24
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$65.98 / $65.98 / $65.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.94 / $306.73 / $501.27
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.89 / $69.31 / $123.66
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$96.64 / $240.06 / $369.69
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$540.32 / $540.32 / $540.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.72 / $296.97 / $1,882.38
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.28 / $58.27 / $434.24
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$115.64 / $238.47 / $1,576.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.72 / $249.10 / $419.62
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.28 / $53.08 / $110.16
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$115.64 / $198.47 / $303.68