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Alaska rates for HCPCS 72128

Computed tomography, thoracic spine; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$147.71 / $262.70 / $441.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.75 / $272.73 / $525.08
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.14 / $63.51 / $210.17
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$177.61 / $221.14 / $314.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.70 / $473.80 / $564.91
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.64 / $152.57 / $175.64
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$127.05 / $298.16 / $412.35
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.43 / $383.31 / $846.95
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$113.23 / $139.21 / $343.64
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$191.37 / $247.44 / $503.36
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$493.75 / $635.00 / $978.93
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$175.00 / $189.00 / $317.37
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$318.75 / $456.25 / $661.56
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.86 / $499.40 / $978.93
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$152.57 / $213.00 / $317.37
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$323.75 / $456.25 / $736.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$379.04 / $568.55 / $964.62
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.00 / $210.78 / $335.85
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$106.82 / $357.78 / $653.41