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Missouri rates for HCPCS 72128

Computed tomography, thoracic spine; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$52.33 / $65.78 / $100.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.80 / $243.92 / $877.07
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.25 / $58.00 / $225.87
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$86.77 / $148.58 / $598.58
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.83 / $91.83 / $91.83
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.89 / $48.98 / $70.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.78 / $190.02 / $492.35
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.69 / $63.94 / $120.51
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.08 / $125.80 / $349.04
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
$112.99 / $229.27 / $453.27
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.27 / $68.11 / $124.66
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$74.09 / $160.24 / $340.70
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$341.52 / $442.24 / $442.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.07 / $278.93 / $1,609.32
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.10 / $69.19 / $379.76
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$106.51 / $213.64 / $1,318.35
Qualchoice
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.61 / $85.61 / $85.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.26 / $227.11 / $389.69
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.47 / $62.44 / $112.75
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$101.30 / $155.76 / $273.94