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Virginia rates for HCPCS 72128

Computed tomography, thoracic spine; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$41.81 / $74.42 / $152.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.04 / $165.62 / $335.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$41.81 / $51.15 / $106.98
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$82.51 / $110.84 / $221.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.62 / $156.81 / $259.25
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.02 / $54.14 / $84.22
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$79.59 / $101.79 / $176.47
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.54 / $226.58 / $891.04
CareFirst
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.90 / $55.48 / $65.91
CareFirst
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$123.31 / $174.68 / $221.84
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
$112.99 / $276.77 / $427.40
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.26 / $66.05 / $118.17
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$80.84 / $196.00 / $332.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.71 / $151.13 / $186.39
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.14 / $52.06 / $62.71
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.56 / $100.28 / $122.89
Medcost
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$83.78 / $95.00 / $171.99
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.97 / $202.40 / $391.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.01 / $210.61 / $399.18
Sentara
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.60 / $70.19 / $106.48
Sentara
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$101.70 / $155.60 / $256.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.42 / $214.57 / $394.24
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.22 / $61.14 / $95.36
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.61 / $150.02 / $310.47