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Utah 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
$70.79 / $70.79 / $70.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $245.47 / $467.74
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $64.57 / $134.90
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$131.83 / $173.78 / $354.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $363.08 / $562.34
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $72.44 / $125.89
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$134.90 / $263.03 / $446.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $446.68
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$323.59 / $323.59 / $323.59
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $371.54 / $602.56
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.18 / $112.20 / $144.54
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$204.17 / $269.15 / $457.09
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $302.00 / $436.52
Select Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.54 / $123.03 / $141.25
Select Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$128.82 / $177.83 / $275.42
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $229.09 / $407.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $281.84 / $467.74
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $54.95 / $107.15
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$144.54 / $199.53 / $371.54