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Pennsylvania rates for HCPCS 72128

Computed tomography, thoracic spine; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$47.72 / $59.08 / $103.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.35 / $181.16 / $877.07
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.35 / $52.46 / $152.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$78.86 / $119.70 / $231.46
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.65 / $78.65 / $125.19
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.43 / $48.77 / $77.40
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.05 / $132.88 / $477.47
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.00 / $76.17 / $134.72
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$81.05 / $119.72 / $374.98
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
$123.83 / $248.42 / $462.34
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.71 / $61.92 / $97.95
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.67 / $168.91 / $335.88
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.59 / $203.25 / $675.73
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.38 / $61.75 / $97.55
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$96.99 / $120.79 / $172.06
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.66 / $155.63 / $164.63
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.51 / $63.16 / $101.87
Highmark BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$151.56 / $151.56 / $151.56
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$45.45 / $64.98 / $155.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.00 / $181.16 / $619.23
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.18 / $60.40 / $151.59
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$80.56 / $113.85 / $299.33
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.65 / $123.30 / $325.00
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$37.97 / $54.02 / $54.02
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.84 / $242.49 / $429.39
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.90 / $62.04 / $100.37
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$84.11 / $167.58 / $335.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$46.50 / $46.50 / $62.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.45 / $129.32 / $289.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.37 / $46.50 / $62.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$81.02 / $82.83 / $227.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.36 / $197.69 / $327.84
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.30 / $57.88 / $92.86
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$90.10 / $133.47 / $243.25