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Michigan rates for HCPCS 72131

Computed tomography, lumbar spine; without contrast material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$60.39 / $60.39 / $64.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.75 / $221.75 / $382.75
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.45 / $60.40 / $198.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$91.32 / $159.68 / $291.63
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.15 / $127.39 / $127.39
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.15 / $46.15 / $81.50
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$58.80 / $58.80 / $58.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.70 / $170.76 / $218.23
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.56 / $74.56 / $74.56
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$135.28 / $135.28 / $135.28
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.27 / $97.36 / $164.55
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
$156.12 / $276.88 / $445.84
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.96 / $64.14 / $117.12
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$105.89 / $171.19 / $308.51
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$39.10 / $60.39 / $64.56
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.71 / $184.06 / $338.62
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.10 / $60.39 / $184.83
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.93 / $144.96 / $242.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.95 / $108.90 / $159.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.02 / $213.46 / $314.73
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.14 / $55.92 / $78.51
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$94.05 / $152.25 / $248.49