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Michigan rates for HCPCS 72128

Computed tomography, thoracic spine; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$60.39 / $60.39 / $63.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.44 / $220.22 / $353.78
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.88 / $60.39 / $142.30
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$92.02 / $157.83 / $291.63
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.43 / $46.15 / $81.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.70 / $157.37 / $226.22
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.38 / $74.56 / $74.56
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$135.81 / $135.81 / $135.81
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.27 / $97.73 / $165.20
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$54.02 / $54.02 / $54.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.12 / $277.58 / $446.43
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.96 / $62.84 / $117.12
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$105.89 / $176.28 / $310.92
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$39.10 / $60.39 / $63.42
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.81 / $184.60 / $313.42
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.10 / $60.39 / $130.38
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$98.31 / $145.49 / $242.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.95 / $108.90 / $159.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.94 / $216.07 / $314.73
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.15 / $57.33 / $82.88
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.79 / $151.50 / $243.37