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Maine rates for HCPCS 72128

Ct Thoracic Spine W/O Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$56.96 / $57.25 / $64.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.73 / $221.75 / $267.14
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.14 / $49.16 / $72.75
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$117.06 / $177.61 / $217.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.88 / $183.63 / $272.98
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.70 / $64.34 / $96.75
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$91.36 / $119.21 / $176.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.69 / $260.00 / $441.00
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.01 / $75.98 / $106.37
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$109.14 / $172.94 / $341.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.82 / $195.93 / $353.45
Harvard Pilgrim
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.71 / $69.44 / $125.28
Harvard Pilgrim
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$105.11 / $126.49 / $228.17
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$56.96 / $57.25 / $64.84
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.21 / $221.75 / $339.70
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.49 / $57.25 / $103.67
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$104.10 / $150.04 / $221.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.58 / $253.35 / $367.41
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.43 / $71.54 / $118.12
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$105.11 / $173.35 / $266.23