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Utah rates for HCPCS C8903

Magnetic Resonance Imaging With Contrast Breast; Unilateral (Special Coverage Instructions Apply)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$475.00 / $1,645.44 / $3,673.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.75 / $318.75 / $475.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$561.00 / $686.40 / $728.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.78 / $691.66 / $1,434.25
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$283.60 / $353.62 / $507.67