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Pennsylvania rates for HCPCS 73220

Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$102.33 / $229.09 / $426.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $512.86 / $2,187.76
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.33 / $177.83 / $478.63
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$295.12 / $426.58 / $1,023.29
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $323.59 / $371.54
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$79.43 / $95.50 / $158.49
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $588.84 / $1,202.26
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$107.15 / $134.90 / $251.19
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$316.23 / $478.63 / $1,096.48
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$25.12 / $117.49 / $165.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $758.58 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.62 / $125.89 / $208.93
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$302.00 / $588.84 / $1,122.02
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $562.34 / $1,584.89
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.00 / $131.83 / $162.18
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$331.13 / $416.87 / $524.81
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $645.65 / $1,122.02
Geisinger
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.10 / $123.03 / $218.78
Geisinger
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$309.03 / $478.63 / $933.25
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $524.81 / $851.14
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$112.20 / $123.03 / $173.78
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$102.33 / $190.55 / $416.87
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $602.56 / $1,380.38
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.33 / $158.49 / $331.13
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$302.00 / $457.09 / $1,000.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $707.95 / $954.99
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$100.00 / $114.82 / $114.82
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $407.38 / $478.63
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$100.00 / $102.33 / $114.82
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$302.00 / $316.23 / $831.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $602.56 / $1,096.48
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$87.10 / $109.65 / $194.98
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$309.03 / $446.68 / $912.01