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Pennsylvania rates for HCPCS 73220

Mri Upper Extrem Other Than Jt W/O & W/Contras

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$106.17 / $138.60 / $289.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.75 / $428.68 / $1,262.25
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.82 / $140.00 / $434.22
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$282.87 / $330.93 / $710.84
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.39 / $317.14 / $352.42
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$77.61 / $83.40 / $157.11
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$407.83 / $407.83 / $407.83
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.11 / $675.32 / $1,744.50
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$108.10 / $165.27 / $250.65
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$315.01 / $510.06 / $1,553.76
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$116.52 / $116.52 / $116.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.17 / $758.65 / $1,397.91
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$73.93 / $124.66 / $201.99
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$281.26 / $594.75 / $1,160.02
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$485.50 / $645.54 / $2,213.21
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$112.17 / $134.46 / $211.93
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$356.77 / $444.28 / $632.85
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.13 / $480.97 / $594.16
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$113.28 / $121.21 / $190.13
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$102.81 / $147.03 / $374.22
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.67 / $475.00 / $1,320.50
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$102.82 / $145.15 / $339.00
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$299.00 / $368.50 / $783.89
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.29 / $425.19 / $844.00
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$70.73 / $116.52 / $116.52
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.15 / $723.45 / $1,343.50
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$76.92 / $124.41 / $201.99
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$296.97 / $572.60 / $1,134.97
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$100.90 / $100.90 / $114.24
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$405.55 / $412.28 / $953.28
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$98.33 / $100.93 / $114.24
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$304.62 / $311.39 / $839.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.75 / $615.91 / $1,125.89
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$93.26 / $118.54 / $198.82
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$317.76 / $452.14 / $862.20