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Utah rates for HCPCS 72149

Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$128.82 / $128.82 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $478.63 / $1,778.28
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.18 / $141.25 / $323.59
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$194.98 / $302.00 / $588.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $524.81 / $851.14
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$72.44 / $102.33 / $181.97
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$181.97 / $371.54 / $645.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $467.74
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$676.08 / $676.08 / $676.08
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $524.81 / $707.95
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$117.49 / $154.88 / $204.17
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$275.42 / $371.54 / $501.19
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $436.52 / $912.01
Select Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.28 / $194.98 / $229.09
Select Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$177.83 / $239.88 / $380.19
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $309.03 / $575.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $407.38 / $660.69
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$72.44 / $77.62 / $151.36
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$190.55 / $269.15 / $537.03