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Washington rates for HCPCS 72100

Radiologic examination, spine, lumbosacral; 2 or 3 views

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.53 / $306.16 / $559.58
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$12.21 / $18.30 / $35.33
Aetna
Facility/Professional
Facility
Modifier
TC
Low / Median / High Price
$35.54 / $299.79 / $564.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.65 / $54.15 / $140.12
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$10.02 / $14.55 / $38.86
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$26.62 / $36.11 / $65.69
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.64 / $75.01 / $105.38
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.25 / $17.23 / $20.81
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$45.90 / $54.67 / $63.29
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.55 / $341.91 / $434.49
Asuris Northwest Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$100.00 / $100.00 / $100.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
TC
Low / Median / High Price
$100.00 / $131.69 / $131.69
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.16 / $95.25 / $346.20
Asuris Northwest Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$14.78 / $25.89 / $135.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$40.19 / $69.13 / $257.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.44 / $373.15 / $498.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.57 / $69.18 / $129.63
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.14 / $19.57 / $32.52
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$26.32 / $47.61 / $97.55
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.02 / $82.75 / $164.40
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$10.54 / $23.68 / $290.81
Kaiser Permanente
Facility/Professional
Facility
Modifier
TC
Low / Median / High Price
$25.03 / $54.59 / $290.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.40 / $72.50 / $106.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$10.63 / $22.74 / $29.53
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$24.09 / $52.04 / $78.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.15 / $54.50 / $92.81
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.75 / $71.69 / $80.40
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$17.14 / $21.12 / $21.76
Pacific Source
Facility/Professional
Facility
Modifier
TC
Low / Median / High Price
$38.19 / $50.25 / $58.96
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$13.67 / $20.48 / $23.36
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$27.74 / $44.89 / $58.80
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.91 / $53.91 / $54.84
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$14.50 / $14.50 / $14.62
Premera BCBS
Facility/Professional
Facility
Modifier
TC
Low / Median / High Price
$39.40 / $39.40 / $40.22
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.86 / $91.48 / $112.48
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$16.44 / $24.77 / $29.99
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$44.50 / $67.08 / $82.48
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$202.73 / $304.02 / $592.49
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$211.40 / $211.40 / $385.75
Regence BlueShield
Facility/Professional
Facility
Modifier
TC
Low / Median / High Price
$211.40 / $211.40 / $385.75
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.98 / $82.20 / $107.78
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$15.36 / $22.14 / $29.88
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$40.19 / $60.28 / $81.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.22 / $44.73 / $109.39
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.18 / $12.80 / $30.82
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$26.92 / $32.79 / $80.23
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.46 / $45.46 / $45.46
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.25 / $11.25 / $11.25
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$34.21 / $34.21 / $34.21