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California rates for HCPCS 72128

Ct Thoracic Spine W/O Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$46.90 / $55.76 / $290.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.81 / $247.94 / $961.35
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.18 / $56.90 / $229.01
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$98.31 / $201.03 / $373.70
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.46 / $161.50 / $231.98
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.79 / $57.30 / $95.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.90 / $322.29 / $584.77
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.31 / $74.27 / $139.71
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$121.25 / $247.86 / $449.35
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.09 / $205.52 / $509.89
Blue Shield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.42 / $61.23 / $144.03
Blue Shield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$100.00 / $145.75 / $368.85
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$54.02 / $54.02 / $54.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.01 / $266.80 / $520.15
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$29.76 / $61.42 / $135.44
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$84.01 / $192.10 / $403.48
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.68 / $169.02 / $228.18
Contra Costa Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$32.42 / $52.29 / $70.59
Contra Costa Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$92.26 / $116.73 / $157.59
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.13 / $175.00 / $309.95
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.25 / $62.75 / $109.55
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$89.98 / $134.97 / $218.87
Lucent Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$430.56 / $430.56 / $442.24
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,609.32 / $1,657.60 / $1,657.60
Lucent Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$379.76 / $379.76 / $379.76
Lucent Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,318.35 / $1,357.90 / $1,357.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $101.49
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$54.02 / $54.02 / $54.02
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.90 / $291.45 / $458.30
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$29.36 / $59.18 / $132.94
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$84.01 / $202.74 / $384.71
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$518.19 / $518.19 / $518.19
Sutter Health Plus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$162.91 / $162.91 / $162.91
Sutter Health Plus
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$355.28 / $355.28 / $355.28
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.69 / $187.96 / $567.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.36 / $200.50 / $466.60
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.66 / $53.59 / $120.60
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$90.80 / $148.22 / $330.29