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Utah rates for HCPCS 74400

Urography (pyelography), intravenous, with or without KUB, with or without tomography

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$26.92 / $26.92 / $26.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $128.82 / $275.42
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$18.20 / $25.12 / $47.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $151.36 / $257.04
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$22.91 / $32.36 / $50.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $141.25
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$323.59 / $323.59 / $323.59
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $223.87 / $257.04
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$32.36 / $42.66 / $56.23
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $204.17 / $263.03
Select Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$21.88 / $36.31 / $50.12
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $154.88 / $257.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $123.03 / $213.80
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.89 / $25.12 / $41.69