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Alaska rates for HCPCS 74248

Radiologic small intestine follow-through study, including multiple serial images (List separately in addition to code for primary procedure for upper GI radiologic examination)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$107.15 / $107.15 / $107.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $93.33 / $257.04
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.70 / $38.90 / $114.82
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$38.02 / $52.48 / $141.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $218.78 / $295.12
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.57 / $107.15 / $123.03
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$112.20 / $134.90 / $181.97
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $213.80 / $338.84
Moda Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$52.48 / $95.50 / $239.88
Moda Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$77.62 / $125.89 / $288.40
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $331.13 / $512.86
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$123.03 / $131.83 / $218.78
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$165.96 / $199.53 / $302.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $169.82 / $229.09
Providence
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.18 / $64.57 / $123.03
Providence
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$44.67 / $63.10 / $144.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $213.80 / $446.68
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$85.11 / $102.33 / $208.93
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$107.15 / $131.83 / $229.09