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Sacroiliac Joint X-ray

New Hampshire rates for HCPCS 72200

This is an X-ray of the sacroiliac joints, the joints where the base of the spine connects to the pelvis, using a limited number of views. It is used to look for signs of arthritis, injury, or inflammation in these joints, which can be a source of low back pain.

Rates data updated July 2026.

Facilitymedian $12 · 10th–90th $8$310%20%10th90th$12Professionalmedian $30 · 10th–90th $9$710%5%10th90th$30$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
26 · Professional part
Typical Low
$8.32
Median
$12.02
Typical High
$30.90
Aetna
Setting
Professional
Modifier
Global
Typical Low
$21.88
Median
$29.51
Typical High
$53.70
Aetna
Setting
Professional
Modifier
26 · Professional part
Typical Low
$6.46
Median
$7.41
Typical High
$13.49
Aetna
Setting
Professional
Modifier
TC · Technical part
Typical Low
$15.49
Median
$21.88
Typical High
$40.74
Ambetter
Setting
Professional
Modifier
26 · Professional part
Typical Low
$10.72
Median
$10.72
Typical High
$10.72
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$53.70
Typical High
$70.79
Anthem BCBS
Setting
Professional
Modifier
26 · Professional part
Typical Low
$8.32
Median
$13.18
Typical High
$18.20
Anthem BCBS
Setting
Professional
Modifier
TC · Technical part
Typical Low
$25.12
Median
$39.81
Typical High
$52.48
Cigna
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$51.29
Typical High
$91.20
Cigna
Setting
Professional
Modifier
26 · Professional part
Typical Low
$8.91
Median
$13.80
Typical High
$23.44
Cigna
Setting
Professional
Modifier
TC · Technical part
Typical Low
$25.12
Median
$38.02
Typical High
$75.86
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$61.66
Typical High
$89.13
Harvard Pilgrim
Setting
Professional
Modifier
26 · Professional part
Typical Low
$9.55
Median
$14.13
Typical High
$21.88
Harvard Pilgrim
Setting
Professional
Modifier
TC · Technical part
Typical Low
$29.51
Median
$42.66
Typical High
$67.61
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$50.12
Typical High
$120.23
United
Setting
Professional
Modifier
26 · Professional part
Typical Low
$9.12
Median
$13.18
Typical High
$25.70
United
Setting
Professional
Modifier
TC · Technical part
Typical Low
$24.55
Median
$35.48
Typical High
$85.11
Well Sense
Setting
Facility
Modifier
26 · Professional part
Typical Low
$6.03
Median
$6.61
Typical High
$7.94