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Alaska rates for HCPCS 72200

Radiologic examination, sacroiliac joints; less than 3 views

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$25.15 / $25.15 / $25.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.78 / $32.81 / $97.18
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$7.33 / $8.55 / $27.71
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$19.46 / $24.25 / $69.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.97 / $81.63 / $116.41
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$12.76 / $26.76 / $30.66
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$38.21 / $54.87 / $88.73
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.22 / $98.01 / $205.76
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.23 / $24.50 / $69.36
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$56.80 / $73.73 / $173.81
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.75 / $136.35 / $201.15
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.25 / $36.00 / $55.88
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$77.50 / $102.60 / $144.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.12 / $108.75 / $189.39
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.00 / $37.50 / $55.88
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$60.00 / $97.50 / $143.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.86 / $85.06 / $188.21
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.94 / $25.54 / $61.69
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$29.19 / $64.45 / $120.83