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Illinois rates for HCPCS 72128

Ct Thoracic Spine W/O Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$49.43 / $77.48 / $141.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.22 / $221.75 / $353.78
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.14 / $56.39 / $159.75
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$86.77 / $160.31 / $231.46
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.65 / $98.32 / $125.19
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.90 / $39.77 / $63.59
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$88.42 / $88.42 / $88.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.94 / $153.46 / $269.95
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$62.76 / $62.76 / $62.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.34 / $214.83 / $428.06
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.64 / $65.94 / $99.64
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.67 / $144.69 / $320.62
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.53 / $237.24 / $1,061.81
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.52 / $82.43 / $370.13
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$96.11 / $148.22 / $803.25
Hally Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.16 / $159.44 / $171.34
Hally Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.10 / $58.18 / $61.23
Hally Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.99 / $102.35 / $110.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $64.06 / $179.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.49 / $252.04 / $393.74
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.48 / $63.91 / $102.50
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$105.74 / $183.51 / $280.30