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Utah rates for HCPCS 21116

Injection procedure for temporomandibular joint arthrography

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $144.54 / $457.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $177.83 / $354.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $85.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $131.83 / $380.19
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $208.93 / $398.11
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $295.12 / $416.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $125.89 / $263.03