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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
$39.29 / $49.09 / $66.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.60 / $167.73 / $375.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.34 / $51.30 / $114.54
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$75.79 / $105.79 / $231.46
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.88 / $103.33 / $170.40
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.65 / $52.45 / $86.89
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$166.04 / $166.04 / $166.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.44 / $103.71 / $159.11
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.15 / $167.15 / $245.00
Christus
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$44.11 / $47.60 / $94.55
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
$109.79 / $203.36 / $423.34
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.90 / $56.41 / $106.68
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$70.43 / $144.83 / $311.37
Lucent Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$341.52 / $430.56 / $442.24
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$941.85 / $1,657.60 / $1,657.60
Lucent Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$379.76 / $379.76 / $379.76
Lucent Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$1,318.35 / $1,357.90 / $1,357.90
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.98 / $191.66 / $365.95
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$58.88 / $74.73 / $191.66
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$107.22 / $136.09 / $329.92
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.93 / $103.28 / $220.09
Providence
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$54.02 / $54.02 / $54.02
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.59 / $232.13 / $413.75
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.13 / $54.22 / $102.63
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$70.43 / $141.19 / $318.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.36 / $192.23 / $355.66
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.19 / $51.25 / $95.77
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$90.80 / $138.86 / $264.17
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.05 / $122.50 / $173.58
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.65 / $44.56 / $61.51
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$70.39 / $82.29 / $1,100.00