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Wisconsin rates for HCPCS 72202

Radiologic examination, sacroiliac joints; 3 or more views

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$15.85 / $22.39 / $27.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $57.54 / $151.36
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$8.91 / $18.20 / $42.66
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$21.88 / $33.11 / $91.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $58.88 / $186.21
Anthem BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$10.00 / $16.22 / $53.70
Anthem BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$25.12 / $42.66 / $141.25
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.80 / $34.67 / $50.12
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$28.18 / $32.36 / $52.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $83.18 / $158.49
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$10.00 / $22.91 / $43.65
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$26.92 / $61.66 / $114.82
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $85.11 / $112.20
DeanCare
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.95 / $23.99 / $30.90
DeanCare
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$52.48 / $60.26 / $79.43
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$100.00 / $100.00 / $169.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $74.13 / $251.19
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$10.96 / $22.91 / $97.72
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$26.30 / $51.29 / $181.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $97.72 / $141.25
Quartz
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$100.00 / $100.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $181.97 / $251.19
Quartz
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$11.75 / $57.54 / $97.72
Quartz
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$28.18 / $125.89 / $181.97
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $177.83 / $245.47
Security Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.89 / $25.70 / $51.29
Security Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$50.12 / $54.95 / $125.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $53.70 / $125.89
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$10.23 / $16.60 / $37.15
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$25.12 / $37.15 / $91.20