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Utah rates for HCPCS 72200

Radiologic examination, sacroiliac joints; less than 3 views

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$8.91 / $8.91 / $8.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $35.48 / $154.88
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$6.31 / $9.33 / $22.91
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$18.62 / $23.99 / $47.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $38.90 / $67.61
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$8.13 / $11.48 / $17.38
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$19.50 / $26.92 / $47.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.79 / $32.36 / $36.31
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$199.53 / $199.53 / $199.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $57.54 / $66.07
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.22 / $14.79 / $19.95
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$35.48 / $40.74 / $46.77
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $51.29 / $63.10
Select Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$7.94 / $13.18 / $18.20
Select Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$23.44 / $38.02 / $44.67
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $37.15 / $61.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $30.90 / $53.70
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$8.13 / $9.12 / $14.79
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$19.95 / $23.44 / $38.90