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Pennsylvania rates for HCPCS 73221

Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$66.07 / $138.04 / $416.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $371.54 / $1,445.44
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.57 / $125.89 / $302.00
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$288.40 / $1,230.27 / $2,041.74
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$61.66 / $512.86 / $1,047.13
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$144.54 / $281.84 / $812.83
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $173.78 / $239.88
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.29 / $87.10 / $100.00
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$77.62 / $165.96 / $213.80
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $354.81 / $562.34
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.18 / $89.13 / $158.49
Capital Blue Cross
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$512.86 / $707.95 / $1,122.02
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$173.78 / $245.47 / $707.95
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$15.49 / $72.44 / $104.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $407.38 / $758.58
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.98 / $79.43 / $134.90
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$131.83 / $302.00 / $660.69
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $281.84 / $1,047.13
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$64.57 / $83.18 / $102.33
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$151.36 / $194.98 / $245.47
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $354.81 / $616.60
Geisinger
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.95 / $77.62 / $138.04
Geisinger
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$131.83 / $288.40 / $446.68
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $234.42 / $416.87
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$69.18 / $72.44 / $104.71
Highmark BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$446.68 / $446.68 / $467.74
Highmark BCBS
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$39.81 / $39.81 / $45.71
Highmark BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$257.04 / $257.04 / $302.00
Independence Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $281.84 / $501.19
Independence Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$72.44 / $81.28 / $107.15
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$66.07 / $125.89 / $416.87
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $426.58 / $1,071.52
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$66.07 / $117.49 / $257.04
Martin's Point
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$275.42 / $1,230.27 / $2,041.74
Martin's Point
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$107.15 / $512.86 / $1,047.13
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$154.88 / $281.84 / $630.96
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $416.87 / $707.95
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$64.57 / $64.57 / $89.13
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $302.00 / $457.09
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$63.10 / $64.57 / $89.13
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$134.90 / $141.25 / $416.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $295.12 / $575.44
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$54.95 / $70.79 / $125.89
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$138.04 / $194.98 / $478.63