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Washington rates for HCPCS 21116

Injection Temporomandibular Joint Arthrography

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.24 / $424.14 / $14,464.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.32 / $126.34 / $400.85
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $387.66 / $519.49
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.98 / $385.61 / $1,840.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.95 / $164.12 / $576.48
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.14 / $143.44 / $414.71
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.49 / $135.00 / $467.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.23 / $324.15 / $547.93
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.15 / $340.37 / $426.12
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.64 / $290.64 / $301.25
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.79 / $249.82 / $564.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.98 / $164.51 / $483.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$414.00 / $666.00 / $6,216.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.69 / $337.19 / $629.49
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.62 / $46.62 / $238.81