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Pennsylvania rates for HCPCS 23350

Injection procedure for shoulder arthrography or enhanced CT/MRI shoulder arthrography

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$217.27 / $533.37 / $4,761.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,283.90 / $1,283.90 / $1,283.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.89 / $123.78 / $263.62
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$88.16 / $126.39 / $126.39
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.63 / $71.84 / $149.28
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$522.48 / $691.16 / $4,388.85
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
$152.51 / $158.27 / $260.44
Capital Blue Cross
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$228.77 / $237.40 / $390.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.79 / $84.79 / $84.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.30 / $152.08 / $283.45
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.20 / $238.06 / $316.47
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$304.17 / $428.55 / $887.82
Highmark BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$716.94 / $716.94 / $716.94
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.17 / $59.59 / $126.21
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$439.01 / $682.09 / $2,792.27
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.65 / $693.30 / $5,627.00
Martin's Point
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,283.90 / $1,283.90 / $2,600.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.04 / $127.22 / $291.52
Martin's Point
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$88.16 / $88.16 / $126.39
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $377.10 / $406.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.79 / $84.79 / $174.64
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.92 / $152.08 / $277.95
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.97 / $124.11 / $290.52
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.97 / $156.78 / $172.06
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
$149.44 / $193.22 / $321.92