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Pennsylvania rates for HCPCS 72133

Ct Lumbar Spine W/O & W/Contrast Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$67.05 / $87.84 / $214.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.79 / $235.83 / $383.66
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.94 / $60.67 / $92.28
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$132.03 / $168.78 / $325.76
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.09 / $61.62 / $93.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.57 / $200.87 / $335.09
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$59.75 / $62.01 / $118.64
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$133.81 / $138.86 / $370.72
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$68.70 / $68.70 / $68.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.56 / $376.09 / $669.69
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.83 / $73.41 / $120.18
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$138.19 / $269.18 / $521.52
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.48 / $309.80 / $988.40
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.37 / $78.45 / $123.88
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$160.13 / $199.39 / $284.00
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$228.44 / $228.44 / $228.44
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$62.61 / $66.77 / $87.21
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$67.05 / $110.49 / $219.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.36 / $235.83 / $541.24
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.56 / $64.69 / $153.43
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$134.46 / $168.78 / $454.61
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.90 / $200.87 / $368.16
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$41.83 / $68.70 / $68.70
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.74 / $359.56 / $649.30
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$46.40 / $73.28 / $122.00
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$138.86 / $265.55 / $504.91
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$59.73 / $59.73 / $68.50
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.62 / $197.56 / $407.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$58.18 / $59.77 / $68.50
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$134.85 / $137.83 / $338.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.95 / $287.38 / $490.40
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.38 / $69.81 / $119.98
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$138.86 / $207.73 / $393.43