Shoppable Services at McKay-Dee Hospital

General Disclosure

The two lists of standard charges displayed represent the pricing information for medical items and services required by the federal Hospital Price Transparency Rule. The pricing information does not necessarily reflect your financial responsibility for your hospital visit, for several reasons, including:

  • The listings reflect prices paid by your insurer for services provided during your hospital visit, which may not reflect your share of the costs for these services under the terms of your health plan.
  • The prices for your insurer are only available if your insurer covers the medical items or services under the terms of your health plan.
  • The actual medical items, including medications, and services that are furnished to you during your visit may vary from what is anticipated.
  • You may receive services or supplies from physicians, practitioners or contractors who are not employed by this hospital; the prices for such services or supplies are not listed here.
  • Your insurer may not be contracted with this hospital for all services. The posted prices will not apply to services for which your insurer has not contracted.

These listings do not guarantee pricing, coverage, benefits, or payments. Your financial liability will be based on the medical items and services billed by the hospital, the terms of your insurance policy, and the status of your benefits (i.e., deductibles, out of pocket maximum, co-insurance, and copays) at the time you receive care. Your eligibility and the amounts covered by your insurance are solely determined by your health insurance provider.

We encourage you to contact a Hospital Cost Estimation Specialist at (855) 442-8601 or INTCostEstimate@R1RCM.com or your insurer to obtain more precise information regarding your potential financial liability.

CDM Bill Item Service Code Service Description Payer Plan Name Inpatient Cash Price Inpatient Min Price Inpatient Max Price Inpatient Negotiated Price Outpatient Cash Price Outpatient Min Price Outpatient Max Price Outpatient Negotiated Price Charge Price
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT 1-800 Contacts 1-800 Contacts $1,749.58 $91.30 $2,164.94 $1,679.59 $886.00 $91.30 $2,164.94 $845.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Global Excel Global Excel $1,749.58 $91.30 $2,164.94 $1,982.85 $886.00 $91.30 $2,164.94 $1,982.85 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Franklin County Medical Center Franklin County Medical Center $1,804.12 $91.30 $2,164.94 $1,731.95 $886.00 $91.30 $2,164.94 $845.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Franklin County Medical Center Franklin County Medical Center $1,749.58 $91.30 $2,164.94 $1,679.59 $886.00 $91.30 $2,164.94 $845.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT University of Utah University of Utah Healthy Premier $1,804.12 $91.30 $2,164.94 $2,044.67 $886.00 $91.30 $2,164.94 $2,044.67 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT University of Utah University of Utah Healthy Premier $1,749.58 $91.30 $2,164.94 $1,982.85 $886.00 $91.30 $2,164.94 $1,982.85 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT University of Utah University of Utah Healthy Preferred $1,749.58 $91.30 $2,164.94 $1,982.85 $886.00 $91.30 $2,164.94 $1,982.85 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT University of Utah University of Utah Healthy Preferred $1,804.12 $91.30 $2,164.94 $2,044.67 $886.00 $91.30 $2,164.94 $2,044.67 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT University of Utah University of Utah Healthy Preferred - Marketplace $1,749.58 $91.30 $2,164.94 $1,982.85 $886.00 $91.30 $2,164.94 $1,982.85 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT University of Utah University of Utah Healthy Preferred - Marketplace $1,804.12 $91.30 $2,164.94 $2,044.67 $886.00 $91.30 $2,164.94 $2,044.67 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT University of Utah University of Utah Healthy Premier - Marketplace $1,804.12 $91.30 $2,164.94 $2,044.67 $886.00 $91.30 $2,164.94 $2,044.67 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT University of Utah University of Utah Healthy Premier - Marketplace $1,749.58 $91.30 $2,164.94 $1,982.85 $886.00 $91.30 $2,164.94 $1,982.85 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Prodegi Corporate Benefit Services, LLC Prodegi Corporate Benefit Services, LLC $1,749.58 $91.30 $2,164.94 $1,912.87 $886.00 $91.30 $2,164.94 $845.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Prodegi Corporate Benefit Services, LLC Prodegi Corporate Benefit Services, LLC $1,804.12 $91.30 $2,164.94 $1,972.50 $886.00 $91.30 $2,164.94 $845.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Petersen, Inc. Petersen, Inc. $1,804.12 $91.30 $2,164.94 $1,731.95 $886.00 $91.30 $2,164.94 $845.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Petersen, Inc. Petersen, Inc. $1,749.58 $91.30 $2,164.94 $1,679.59 $886.00 $91.30 $2,164.94 $845.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Franklin County Franklin County $1,804.12 $91.30 $2,164.94 $1,731.95 $886.00 $91.30 $2,164.94 $845.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Franklin County Franklin County $1,749.58 $91.30 $2,164.94 $1,679.59 $886.00 $91.30 $2,164.94 $845.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT EMI Health EMI Health $1,749.58 $91.30 $2,164.94 $1,562.96 $886.00 $91.30 $2,164.94 $845.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT EMI Health EMI Health Choice $1,749.58 $91.30 $2,164.94 $1,982.85 $886.00 $91.30 $2,164.94 $1,982.85 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT EMI Health EMI Health Choice $1,804.12 $91.30 $2,164.94 $2,044.67 $886.00 $91.30 $2,164.94 $2,044.67 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT EMI Health EMI Health Network Care $1,749.58 $91.30 $2,164.94 $1,618.94 $886.00 $91.30 $2,164.94 $845.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT EMI Health EMI Health Network Care $1,804.12 $91.30 $2,164.94 $1,669.41 $886.00 $91.30 $2,164.94 $845.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT EMI Health EMI Health $1,804.12 $91.30 $2,164.94 $1,611.68 $886.00 $91.30 $2,164.94 $845.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT United Healthcare United Healthcare Options PPO $1,804.12 $91.30 $2,164.94 $2,044.67 $886.00 $91.30 $2,164.94 $2,044.67 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT United Healthcare United Healthcare Choice Plus Network $1,749.58 $91.30 $2,164.94 $1,656.27 $886.00 $91.30 $2,164.94 $1,656.27 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT United Healthcare United Healthcare Choice Plus Network $1,804.12 $91.30 $2,164.94 $1,707.90 $886.00 $91.30 $2,164.94 $1,707.90 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT United Healthcare United Healthcare Options PPO $1,749.58 $91.30 $2,164.94 $1,982.85 $886.00 $91.30 $2,164.94 $1,982.85 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT CCCM CCCM $1,749.58 $91.30 $2,164.94 $2,076.17 $886.00 $91.30 $2,164.94 $2,076.17 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT CCCM CCCM $1,804.12 $91.30 $2,164.94 $2,140.89 $886.00 $91.30 $2,164.94 $2,140.89 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Big-D Construction Big-D Construction $1,804.12 $91.30 $2,164.94 $1,731.95 $886.00 $91.30 $2,164.94 $845.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Big-D Construction Big-D Construction $1,749.58 $91.30 $2,164.94 $1,679.59 $886.00 $91.30 $2,164.94 $845.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT PEHP PEHP Advantage Care - Non State $1,749.58 $91.30 $2,164.94 $1,670.26 $886.00 $91.30 $2,164.94 $845.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT PEHP PEHP Advantage Care - Non State $1,804.12 $91.30 $2,164.94 $1,722.33 $886.00 $91.30 $2,164.94 $845.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT PEHP PEHP Preferred Care $1,749.58 $91.30 $2,164.94 $2,076.17 $886.00 $91.30 $2,164.94 $2,076.17 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Dixie State University Dixie State University $1,804.12 $91.30 $2,164.94 $1,731.95 $886.00 $91.30 $2,164.94 $845.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Union Pacific Railroad Employes Health Union Pacific Railroad Employes Health $1,749.58 $91.30 $2,164.94 $2,099.49 $886.00 $91.30 $2,164.94 $2,099.49 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Union Pacific Railroad Employes Health Union Pacific Railroad Employes Health $1,804.12 $91.30 $2,164.94 $2,164.94 $886.00 $91.30 $2,164.94 $2,164.94 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Dixie State University Dixie State University $1,749.58 $91.30 $2,164.94 $1,679.59 $886.00 $91.30 $2,164.94 $845.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Deseret Mutual DMBA Deseret Value $1,749.58 $91.30 $2,164.94 $1,448.65 $886.00 $91.30 $2,164.94 $845.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Deseret Mutual DMBA Deseret Select $1,749.58 $91.30 $2,164.94 $1,327.35 $886.00 $91.30 $2,164.94 $845.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Deseret Mutual DMBA Deseret Select $1,804.12 $91.30 $2,164.94 $1,368.72 $886.00 $91.30 $2,164.94 $845.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Deseret Mutual DMBA Deseret Premier $1,749.58 $91.30 $2,164.94 $1,448.65 $886.00 $91.30 $2,164.94 $845.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT BYU Risk Management BYU Risk Management $1,804.12 $91.30 $2,164.94 $1,683.84 $886.00 $91.30 $2,164.94 $1,756.01 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT BYU Risk Management BYU Risk Management $1,749.58 $91.30 $2,164.94 $1,632.94 $886.00 $91.30 $2,164.94 $1,702.92 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT PEHP PEHP Summit Exclusive $1,804.12 $91.30 $2,164.94 $2,044.67 $886.00 $91.30 $2,164.94 $2,044.67 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT PEHP PEHP Advantage Care State Employees and Advantage Care Exclusive $1,804.12 $91.30 $2,164.94 $1,681.44 $886.00 $91.30 $2,164.94 $845.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT PEHP PEHP Capital Care $1,749.58 $91.30 $2,164.94 $1,982.85 $886.00 $91.30 $2,164.94 $1,982.85 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT PEHP PEHP Capital Care $1,804.12 $91.30 $2,164.94 $2,044.67 $886.00 $91.30 $2,164.94 $2,044.67 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT PEHP PEHP Advantage Care State Employees and Advantage Care Exclusive $1,749.58 $91.30 $2,164.94 $1,630.61 $886.00 $91.30 $2,164.94 $845.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT PEHP PEHP Summit Care $1,749.58 $91.30 $2,164.94 $1,982.85 $886.00 $91.30 $2,164.94 $1,982.85 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT PEHP PEHP Summit Care $1,804.12 $91.30 $2,164.94 $2,044.67 $886.00 $91.30 $2,164.94 $2,044.67 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT PEHP PEHP Preferred Care $1,804.12 $91.30 $2,164.94 $2,140.89 $886.00 $91.30 $2,164.94 $2,140.89 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT PEHP PEHP Summit Exclusive $1,749.58 $91.30 $2,164.94 $1,982.85 $886.00 $91.30 $2,164.94 $1,982.85 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Deseret Mutual DMBA Deseret Premier $1,804.12 $91.30 $2,164.94 $1,493.81 $886.00 $91.30 $2,164.94 $845.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT MotivHealth MotivHealth $1,749.58 $91.30 $2,164.94 $1,982.85 $886.00 $91.30 $2,164.94 $1,982.85 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT MotivHealth MotivHealth $1,804.12 $91.30 $2,164.94 $2,044.67 $886.00 $91.30 $2,164.94 $2,044.67 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Molina Healthcare of Utah Molina Marketplace $1,749.58 $91.30 $2,164.94 $1,924.54 $886.00 $91.30 $2,164.94 $1,924.54 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Molina Healthcare of Utah Molina CHIP $1,749.58 $91.30 $2,164.94 $1,924.54 $886.00 $91.30 $2,164.94 $1,924.54 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Molina Healthcare of Utah Molina CHIP $1,804.12 $91.30 $2,164.94 $1,984.53 $886.00 $91.30 $2,164.94 $1,984.53 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT SelectHealth SelectHealth Value Network Individual Plan (ACA) $1,749.58 $91.30 $2,164.94 $615.85 $886.00 $91.30 $2,164.94 $615.85 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT SelectHealth SelectHealth Med Network Federal Employee (FEHBP) $1,749.58 $91.30 $2,164.94 $1,248.03 $886.00 $91.30 $2,164.94 $474.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT SelectHealth SelectHealth Care Network $1,749.58 $91.30 $2,164.94 $1,311.02 $886.00 $91.30 $2,164.94 $474.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT SelectHealth SelectHealth Value Network $1,749.58 $91.30 $2,164.94 $1,098.73 $886.00 $91.30 $2,164.94 $474.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT SelectHealth SelectHealth Value Network $1,804.12 $91.30 $2,164.94 $1,132.99 $886.00 $91.30 $2,164.94 $474.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT SelectHealth SelectHealth Share Network $1,749.58 $91.30 $2,164.94 $1,098.73 $886.00 $91.30 $2,164.94 $474.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT SelectHealth SelectHealth Share Network $1,804.12 $91.30 $2,164.94 $1,132.99 $886.00 $91.30 $2,164.94 $474.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT SelectHealth SelectHealth Care Network $1,804.12 $91.30 $2,164.94 $1,351.89 $886.00 $91.30 $2,164.94 $474.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT SelectHealth SelectHealth Med Network CHIP $1,804.12 $91.30 $2,164.94 $1,286.94 $886.00 $91.30 $2,164.94 $474.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT SelectHealth SelectHealth Med Network CHIP $1,749.58 $91.30 $2,164.94 $1,248.03 $886.00 $91.30 $2,164.94 $474.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT SelectHealth SelectHealth Med Network $1,804.12 $91.30 $2,164.94 $1,286.94 $886.00 $91.30 $2,164.94 $474.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT SelectHealth SelectHealth Med Network $1,749.58 $91.30 $2,164.94 $1,248.03 $886.00 $91.30 $2,164.94 $474.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT SelectHealth SelectHealth Med Network Individual Plan (ACA) $1,749.58 $91.30 $2,164.94 $695.17 $886.00 $91.30 $2,164.94 $695.17 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT SelectHealth SelectHealth Med Network Individual Plan (ACA) $1,804.12 $91.30 $2,164.94 $716.84 $886.00 $91.30 $2,164.94 $716.84 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT SelectHealth SelectHealth Value Network Individual Plan (ACA) $1,804.12 $91.30 $2,164.94 $635.05 $886.00 $91.30 $2,164.94 $635.05 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT SelectHealth SelectHealth Med Network Federal Employee (FEHBP) $1,804.12 $91.30 $2,164.94 $1,286.94 $886.00 $91.30 $2,164.94 $474.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Regence BlueCross BlueShield of Utah Regence BCBS Traditional Plan $1,749.58 $91.30 $2,164.94 $1,936.20 $886.00 $91.30 $2,164.94 $1,008.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Regence BlueCross BlueShield of Utah Regence BCBS Preferred BlueOption (PBO) $1,804.12 $91.30 $2,164.94 $1,852.23 $886.00 $91.30 $2,164.94 $1,008.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Regence BlueCross BlueShield of Utah Regence BCBS Traditional Plan $1,804.12 $91.30 $2,164.94 $1,996.56 $886.00 $91.30 $2,164.94 $1,008.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Regence BlueCross BlueShield of Utah Regence BCBS Preferred BlueOption (PBO) $1,749.58 $91.30 $2,164.94 $1,796.23 $886.00 $91.30 $2,164.94 $1,008.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Regence BlueCross BlueShield of Utah Regence Focal Point $1,804.12 $91.30 $2,164.94 $1,683.84 $886.00 $91.30 $2,164.94 $1,683.84 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Regence BlueCross BlueShield of Utah Regence Focal Point $1,749.58 $91.30 $2,164.94 $1,632.94 $886.00 $91.30 $2,164.94 $1,632.94 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Regence BlueCross BlueShield of Utah Regence Bridgespan RealValue $1,804.12 $91.30 $2,164.94 $1,683.84 $886.00 $91.30 $2,164.94 $1,683.84 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Regence BlueCross BlueShield of Utah Regence Bridgespan RealValue $1,749.58 $91.30 $2,164.94 $1,632.94 $886.00 $91.30 $2,164.94 $1,632.94 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Regence BlueCross BlueShield of Utah Regence BCBS ValueCare $1,804.12 $91.30 $2,164.94 $1,683.84 $886.00 $91.30 $2,164.94 $1,683.84 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Regence BlueCross BlueShield of Utah Regence Individual and Family Network $1,804.12 $91.30 $2,164.94 $1,683.84 $886.00 $91.30 $2,164.94 $1,683.84 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Regence BlueCross BlueShield of Utah Regence Individual and Family Network $1,749.58 $91.30 $2,164.94 $1,632.94 $886.00 $91.30 $2,164.94 $1,632.94 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Regence BlueCross BlueShield of Utah Regence BCBS ValueCare $1,749.58 $91.30 $2,164.94 $1,632.94 $886.00 $91.30 $2,164.94 $1,632.94 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Regence BlueCross BlueShield of Utah Regence BCBS Federal (FEHBP) $1,804.12 $91.30 $2,164.94 $1,828.17 $886.00 $91.30 $2,164.94 $1,008.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Regence BlueCross BlueShield of Utah Regence BCBS Federal (FEHBP) $1,749.58 $91.30 $2,164.94 $1,772.91 $886.00 $91.30 $2,164.94 $1,008.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Aetna Aetna Standard Network AKA Aetna Health Plan Network for Utah $1,804.12 $91.30 $2,164.94 $2,044.67 $886.00 $91.30 $2,164.94 $2,044.67 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Aetna Aetna Standard Network AKA Aetna Health Plan Network for Utah $1,749.58 $91.30 $2,164.94 $1,982.85 $886.00 $91.30 $2,164.94 $1,982.85 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Aetna Aetna Utah Connected Network $1,804.12 $91.30 $2,164.94 $1,924.39 $886.00 $91.30 $2,164.94 $1,008.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Aetna Aetna Utah Connected Network $1,749.58 $91.30 $2,164.94 $1,866.22 $886.00 $91.30 $2,164.94 $1,008.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Provider Networks of America Provider Networks of America (PNOA) $1,804.12 $91.30 $2,164.94 $1,804.12 $886.00 $91.30 $2,164.94 $845.00 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Provider Networks of America Provider Networks of America (PNOA) $1,749.58 $91.30 $2,164.94 $1,749.58 $886.00 $91.30 $2,164.94 $845.00 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT Molina Healthcare of Utah Molina Marketplace $1,804.12 $91.30 $2,164.94 $1,984.53 $886.00 $91.30 $2,164.94 $1,984.53 $2,405.49
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT MedCare International, Inc. MedCare International, Inc. $1,749.58 $91.30 $2,164.94 $1,982.85 $886.00 $91.30 $2,164.94 $1,982.85 $2,332.77
1700001309 1168984 73721 / MRI JNT OF LWR EXTRE W/O CONT MedCare International, Inc. MedCare International, Inc. $1,804.12 $91.30 $2,164.94 $2,044.67 $886.00 $91.30 $2,164.94 $2,044.67 $2,405.49