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Maine rates for HCPCS 72128

Computed tomography, thoracic spine; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$57.54 / $57.54 / $64.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $204.17 / $467.74
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.69 / $57.54 / $169.82
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$91.20 / $131.83 / $309.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $190.55 / $478.63
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $66.07 / $154.88
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.18 / $123.03 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $281.84 / $588.84
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $69.18 / $131.83
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$109.65 / $194.98 / $398.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $199.53 / $389.05
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.23 / $70.79 / $131.83
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$102.33 / $128.82 / $251.19
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$57.54 / $57.54 / $64.57
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $229.09 / $524.81
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.71 / $70.79 / $158.49
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$100.00 / $151.36 / $331.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $251.19 / $436.52
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.98 / $70.79 / $131.83
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.72 / $173.78 / $302.00