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Michigan rates for HCPCS 72133

Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$77.62 / $77.62 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $263.03 / $588.84
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $66.07 / $138.04
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$131.83 / $190.55 / $380.19
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.71 / $52.48 / $85.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $295.12 / $316.23
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$95.50 / $95.50 / $128.82
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$14.45 / $67.61 / $97.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $371.54 / $691.83
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$50.12 / $83.18 / $173.78
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$144.54 / $269.15 / $512.86
Health Alliance Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$52.48 / $123.03 / $144.54
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $295.12 / $575.44
Health Alliance Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $69.18 / $138.04
Health Alliance Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$141.25 / $229.09 / $426.58
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$14.45 / $67.61 / $97.72
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $288.40 / $676.08
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.77 / $66.07 / $131.83
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$117.49 / $208.93 / $512.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $309.03 / $489.78
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.23 / $66.07 / $104.71
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$151.36 / $229.09 / $380.19