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South Carolina rates for HCPCS 72128

Ct Thoracic Spine W/O Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$70.45 / $83.00 / $102.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.13 / $275.00 / $357.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.14 / $62.14 / $115.01
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$92.71 / $192.00 / $252.15
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.31 / $167.91 / $167.91
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$22.02 / $46.72 / $78.83
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$67.75 / $105.39 / $105.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.31 / $340.00 / $486.25
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.04 / $127.00 / $174.26
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$75.28 / $213.00 / $327.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.49 / $262.68 / $467.48
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.24 / $67.01 / $121.00
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$110.02 / $201.98 / $347.94
Medcost
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$83.78 / $97.00 / $171.99
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.83 / $88.83 / $483.44
Medcost
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$175.09 / $175.09 / $175.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.14 / $118.03 / $176.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.99 / $227.49 / $422.60
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.94 / $64.31 / $107.71
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$100.62 / $157.38 / $325.50