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Utah rates for HCPCS 0412T

Removal of permanent cardiac contractility modulation system; pulse generator only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $5,888.44 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $239.88 / $281.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $60.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,754.40 / $6,760.83 / $14,125.38
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $302.00 / $338.84
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $316.23 / $331.13
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $323.59 / $371.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,128.61 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $295.12 / $478.63