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Texas rates for HCPCS 72128

Computed tomography, thoracic spine; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$40.74 / $48.98 / $67.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $181.97 / $512.86
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.69 / $60.26 / $173.78
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$79.43 / $120.23 / $281.84
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $112.20 / $128.82
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.67 / $45.71 / $79.43
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
$38.02 / $102.33 / $141.25
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $181.97 / $245.47
Christus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.65 / $95.50 / $95.50
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$11.48 / $53.70 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $213.80 / $436.52
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.81 / $61.66 / $114.82
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$79.43 / $154.88 / $323.59
Lucent Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$426.58 / $426.58 / $426.58
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $1,659.59 / $1,659.59
Lucent Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$380.19 / $380.19 / $380.19
Lucent Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,348.96
Moda Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$40.74 / $47.86 / $67.61
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $223.87 / $501.19
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.65 / $63.10 / $151.36
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.18 / $128.82 / $295.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $107.15
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $125.89 / $363.08
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$11.48 / $53.70 / $75.86
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $218.78 / $416.87
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.81 / $57.54 / $97.72
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$79.43 / $147.91 / $309.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $194.98 / $363.08
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.69 / $51.29 / $93.33
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$91.20 / $138.04 / $263.03
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $154.88
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.71 / $47.86 / $56.23
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$79.43 / $79.43 / $100.00