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Utah rates for HCPCS 73050

Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$12.02 / $12.02 / $12.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.99 / $42.66 / $147.91
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$7.94 / $13.18 / $37.15
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$54.95 / $54.95 / $54.95
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$15.85 / $25.12 / $66.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $43.65 / $69.18
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$9.55 / $13.49 / $20.89
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$21.88 / $30.20 / $51.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.78 / $33.11 / $64.57
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$147.91 / $147.91 / $147.91
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $52.48 / $85.11
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$12.59 / $16.60 / $25.12
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$28.18 / $36.31 / $60.26
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.18 / $44.67 / $63.10
Select Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$8.91 / $14.13 / $20.89
Select Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$19.05 / $30.20 / $41.69
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $31.62 / $56.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $35.48 / $52.48
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$8.71 / $10.72 / $16.22
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$20.89 / $25.12 / $36.31