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Wisconsin rates for HCPCS 72128

Computed tomography, thoracic spine; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$91.20 / $104.71 / $363.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $245.47 / $512.86
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$42.66 / $67.61 / $186.21
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.18 / $128.82 / $288.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $245.47 / $758.58
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.71 / $70.79 / $269.15
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$83.18 / $177.83 / $512.86
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $102.33 / $169.82
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$123.03 / $144.54 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $354.81 / $537.03
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.65 / $97.72 / $190.55
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$114.82 / $251.19 / $354.81
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $288.40 / $457.09
DeanCare
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.10 / $104.71 / $141.25
DeanCare
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$154.88 / $186.21 / $331.13
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$446.68 / $446.68 / $446.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $380.19 / $1,621.81
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.70 / $114.82 / $380.19
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$120.23 / $263.03 / $1,318.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $245.47
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $331.13 / $933.25
Quartz
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$109.65 / $426.58 / $426.58
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $933.25 / $1,659.59
Quartz
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.07 / $245.47 / $380.19
Quartz
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$134.90 / $741.31 / $1,348.96
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $831.76 / $1,122.02
Security Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$165.96 / $194.98 / $229.09
Security Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$302.00 / $457.09 / $616.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $281.84 / $616.60
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $79.43 / $177.83
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$102.33 / $204.17 / $457.09