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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
$60.26 / $60.26 / $75.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $213.80 / $562.34
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.65 / $67.61 / $186.21
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$85.11 / $125.89 / $316.23
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $97.72 / $104.71
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.67 / $45.71 / $89.13
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$109.65 / $109.65 / $109.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $194.98 / $208.93
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.13 / $74.13 / $100.00
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$134.90 / $134.90 / $181.97
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $102.33 / $169.82
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$11.48 / $53.70 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $251.19 / $467.74
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.81 / $66.07 / $134.90
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$91.20 / $162.18 / $323.59
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$58.88 / $60.26 / $104.71
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $213.80 / $436.52
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.65 / $61.66 / $169.82
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$91.20 / $144.54 / $309.03
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$11.48 / $53.70 / $75.86
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $223.87 / $467.74
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.15 / $56.23 / $104.71
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$70.79 / $158.49 / $309.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $208.93 / $331.13
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.67 / $56.23 / $83.18
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.50 / $144.54 / $251.19