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Maryland rates for HCPCS 72128

Ct Thoracic Spine W/O Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$40.28 / $54.98 / $80.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.52 / $221.75 / $701.52
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.81 / $52.10 / $158.26
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$78.23 / $148.63 / $314.14
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.54 / $226.58 / $287.76
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.90 / $51.90 / $65.91
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$123.31 / $174.68 / $221.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.33 / $253.10 / $414.56
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.52 / $58.72 / $110.62
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$77.06 / $177.78 / $305.97
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.22 / $175.74 / $295.77
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.61 / $56.69 / $97.59
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$88.99 / $114.80 / $220.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.17 / $186.92 / $336.73
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$29.05 / $51.25 / $95.01
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$91.31 / $130.07 / $255.98
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.98 / $147.88 / $192.26
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.79 / $49.58 / $64.45
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$71.19 / $98.31 / $125.69