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Montana rates for HCPCS 74712

Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; single or first gestation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,338.78 / $2,338.78 / $2,603.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.52 / $475.00 / $638.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,234.41 / $77,999.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.89 / $221.89 / $662.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$557.45 / $664.02 / $968.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.90 / $631.75 / $1,120.58
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.91 / $662.51 / $968.97
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.32 / $695.57 / $1,073.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.60 / $424.69 / $844.21