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Utah rates for HCPCS 0164U

Gastroenterology (irritable bowel syndrome [IBS]), immunoassay for anti-CdtB and anti-vinculin antibodies, utilizing plasma, algorithm for elevated or not elevated qualitative results

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $537.03 / $707.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $89.13 / $107.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $97.72 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $162.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $44.67
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $112.20 / $524.81
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $95.50 / $100.00
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $112.20 / $323.59
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $97.72 / $169.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $56.23 / $72.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $46.77 / $89.13