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Pennsylvania rates for HCPCS 74221

Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; double-contrast (eg, high-density barium and effervescent agent) study

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$31.37 / $35.82 / $64.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.17 / $107.61 / $400.00
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.20 / $32.90 / $77.73
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$63.65 / $74.53 / $130.10
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.55 / $102.55 / $102.55
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.71 / $35.74 / $57.68
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.73 / $131.37 / $195.95
Capital Blue Cross
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.22 / $43.86 / $65.44
Capital Blue Cross
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$71.52 / $87.51 / $134.52
Cigna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$37.82 / $37.82 / $37.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.97 / $131.88 / $203.29
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$24.12 / $41.98 / $65.81
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$58.46 / $90.09 / $143.10
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.27 / $145.38 / $176.93
Emblem Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.40 / $43.63 / $68.77
Emblem Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$85.59 / $106.56 / $151.80
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.02 / $130.91 / $132.90
Highmark BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.99 / $39.36 / $49.70
Martin's Point
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$29.88 / $43.33 / $104.22
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.39 / $117.76 / $337.65
Martin's Point
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$29.87 / $36.63 / $82.45
Martin's Point
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$67.45 / $81.89 / $175.24
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.59 / $127.50 / $201.18
Priority Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$37.82 / $37.82 / $37.82
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.18 / $131.03 / $203.08
Priority Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$24.82 / $41.98 / $66.06
Priority Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$58.80 / $89.85 / $144.34
UPMC Health Plan
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$32.85 / $32.85 / $38.60
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.18 / $107.78 / $116.55
UPMC Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.99 / $32.89 / $38.60
UPMC Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$73.30 / $74.92 / $82.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.59 / $121.47 / $205.02
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.58 / $38.96 / $64.87
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$63.01 / $82.17 / $133.11