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South Carolina rates for HCPCS 72128

Computed tomography, thoracic spine; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$61.66 / $83.18 / $104.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $234.42 / $446.68
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.65 / $70.79 / $169.82
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.18 / $162.18 / $288.40
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $107.15 / $134.90
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.48 / $44.67 / $74.13
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$77.62 / $77.62 / $109.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $275.42 / $501.19
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $95.50 / $165.96
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$81.28 / $158.49 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $263.03 / $489.78
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.98 / $66.07 / $114.82
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$100.00 / $194.98 / $346.74
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Medcost
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$93.33 / $93.33 / $93.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $245.47 / $446.68
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $61.66 / $104.71
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.72 / $177.83 / $338.84