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Georgia rates for HCPCS 72128

Computed tomography, thoracic spine; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$54.95 / $83.18 / $218.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $257.04 / $616.60
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.65 / $64.57 / $186.21
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.18 / $169.82 / $309.03
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $89.13 / $218.78
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.67 / $50.12 / $79.43
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$77.62 / $109.65 / $162.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $263.03 / $457.09
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $72.44 / $114.82
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$104.71 / $190.55 / $354.81
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $91.20 / $162.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $302.00 / $537.03
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.65 / $75.86 / $141.25
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$114.82 / $208.93 / $389.05
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $173.78 / $758.58
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $63.10 / $234.42
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$85.11 / $109.65 / $758.58
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $104.71 / $218.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $257.04 / $436.52
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $64.57 / $112.20
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.50 / $181.97 / $309.03