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Pennsylvania rates for HCPCS 73221

Mri Any Jt Upper Extremity W/O Contrast Matrl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$66.50 / $96.67 / $241.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.56 / $402.08 / $1,262.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.42 / $129.47 / $284.00
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$1,218.00 / $1,218.00 / $1,218.00
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$103.30 / $200.00 / $237.50
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$142.55 / $299.00 / $502.50
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.59 / $158.90 / $226.70
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.33 / $66.02 / $105.65
Ambetter
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$101.32 / $212.05 / $212.05
AmeriHealth
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.58 / $306.39 / $1,007.80
AmeriHealth
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$74.37 / $87.32 / $1,768.19
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.16 / $352.63 / $819.35
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$82.23 / $104.86 / $156.72
Capital Blue Cross
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$514.32 / $705.25 / $1,638.66
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$176.25 / $242.86 / $700.08
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$73.64 / $73.64 / $73.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.80 / $392.00 / $810.23
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$47.07 / $78.50 / $129.09
Cigna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$301.29 / $343.71 / $343.71
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$126.63 / $301.00 / $664.09
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.63 / $320.67 / $1,252.85
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.16 / $84.28 / $132.97
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$163.22 / $203.13 / $289.26
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.24 / $245.32 / $415.39
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.45 / $79.81 / $111.66
Highmark BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$443.94 / $443.94 / $469.62
Highmark BCBS
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$39.40 / $39.40 / $39.40
Highmark BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$163.16 / $254.21 / $254.55
Independence Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.27 / $306.11 / $547.58
Independence Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$67.42 / $80.41 / $500.00
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$65.42 / $94.85 / $249.47
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.00 / $400.00 / $1,330.26
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$65.42 / $126.00 / $279.72
Martin's Point
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$277.26 / $1,218.00 / $1,218.00
Martin's Point
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$104.35 / $200.00 / $352.75
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$143.27 / $299.00 / $729.56
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.61 / $226.71 / $700.00
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$44.19 / $73.64 / $73.64
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.36 / $381.88 / $767.85
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$49.61 / $77.87 / $131.36
Priority Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$301.29 / $343.71 / $366.14
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$131.15 / $293.85 / $660.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$64.02 / $64.02 / $89.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.81 / $202.80 / $510.50
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$62.40 / $64.03 / $89.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$135.78 / $138.78 / $421.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.75 / $299.62 / $598.32
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$60.10 / $76.70 / $127.60
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$137.57 / $198.72 / $462.94