go back

South Dakota rates for HCPCS 72128

Computed tomography, thoracic spine; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$34.67 / $47.86 / $47.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $181.97 / $489.78
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.65 / $70.79 / $173.78
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$79.43 / $112.20 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $316.23 / $398.11
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.10 / $109.65 / $138.04
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$165.96 / $204.17 / $257.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $281.84 / $512.86
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.95 / $87.10 / $141.25
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$125.89 / $194.98 / $1,318.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $281.84 / $363.08
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$95.50 / $100.00 / $117.49
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$165.96 / $181.97 / $245.47
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $316.23
Midlands
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$104.71 / $104.71 / $104.71
Midlands
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$213.80 / $213.80 / $213.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $257.04 / $363.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$58.88 / $77.62 / $91.20
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$114.82 / $165.96 / $288.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $288.40 / $398.11
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.95 / $85.11 / $107.15
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$102.33 / $194.98 / $288.40
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $295.12 / $295.12
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$89.13 / $104.71 / $104.71
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$162.18 / $190.55 / $190.55