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Utah 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
$478.63 / $1,659.59 / $3,801.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $478.63 / $1,122.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $691.83 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $562.34 / $933.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $977.24
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $794.33 / $1,122.02
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $794.33 / $1,047.13
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $676.08 / $912.01
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $436.52 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $416.87 / $794.33