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Pennsylvania rates for HCPCS 21116

Injection Temporomandibular Joint Arthrography

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$235.49 / $2,070.00 / $7,629.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.79 / $147.86 / $237.54
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.77 / $206.27 / $340.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.98 / $74.98 / $74.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.11 / $163.96 / $326.89
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.28 / $313.11 / $414.17
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$617.00 / $2,326.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.08 / $156.76 / $485.11
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.50 / $319.70 / $479.30
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.98 / $74.98 / $201.76
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.64 / $163.96 / $325.64
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.82 / $119.59 / $306.19
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.82 / $204.33 / $226.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.00 / $1,078.00 / $3,742.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.40 / $231.34 / $380.18