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Washington rates for HCPCS 74240

Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$42.92 / $67.40 / $119.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.04 / $131.28 / $310.86
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$29.91 / $42.93 / $97.85
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$71.14 / $92.23 / $209.98
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.20 / $63.89 / $66.94
Asuris Northwest Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$100.00 / $172.60 / $172.60
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.18 / $302.04 / $1,057.20
Asuris Northwest Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.21 / $90.44 / $313.64
Asuris Northwest Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$105.26 / $204.80 / $743.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.77 / $203.74 / $395.88
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.81 / $63.36 / $114.65
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$76.48 / $142.36 / $284.12
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$40.59 / $75.76 / $490.69
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.39 / $228.32 / $330.48
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.45 / $72.78 / $97.75
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$78.84 / $156.06 / $237.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.90 / $110.49 / $296.23
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$56.43 / $73.09 / $76.84
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.19 / $119.19 / $132.44
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.79 / $59.40 / $77.59
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$95.52 / $135.11 / $171.01
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$51.19 / $51.19 / $51.64
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.10 / $288.06 / $344.93
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$57.14 / $87.46 / $107.58
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$128.94 / $197.83 / $239.01
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$346.39 / $346.39 / $851.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.17 / $252.08 / $340.03
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$53.00 / $77.64 / $106.04
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$121.97 / $176.43 / $239.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.40 / $134.57 / $335.01
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.45 / $45.13 / $108.30
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$76.69 / $92.00 / $225.22
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.68 / $137.68 / $137.68
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.93 / $39.93 / $39.93
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$97.75 / $97.75 / $97.75