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Nebraska rates for HCPCS 74221

Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; double-contrast (eg, high-density barium and effervescent agent) study

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$31.82 / $31.82 / $31.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.89 / $117.76 / $437.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.82 / $64.00 / $119.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$68.67 / $73.11 / $431.48
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.33 / $236.33 / $236.33
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.11 / $60.90 / $74.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.61 / $202.68 / $207.75
BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$58.06 / $62.06 / $63.60
BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$131.56 / $140.62 / $144.13
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$183.18 / $183.18 / $183.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.77 / $240.85 / $317.07
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.74 / $73.06 / $94.05
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$80.55 / $161.19 / $223.01
Medica
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$149.85 / $149.85 / $149.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.12 / $198.46 / $730.62
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$40.90 / $66.48 / $210.44
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$81.20 / $131.97 / $520.19
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$99.36 / $102.26 / $183.18
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.36 / $242.38 / $366.80
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.78 / $76.44 / $177.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.12 / $198.46 / $249.64
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$40.90 / $66.48 / $83.62
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$81.20 / $136.38 / $166.02