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Utah rates for HCPCS 0495T

Initiation and monitoring marginal (extended) cadaver donor lung(s) organ perfusion system by physician or qualified health care professional, including physiological and laboratory assessment (eg, pulmonary artery flow, pulmonary artery pressure, left atrial pressure, pulmonary vascular resistance, mean/peak and plateau airway pressure, dynamic compliance and perfusate gas analysis), including bronchoscopy and X ray when performed; first two hours in sterile field

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.23 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $323.59 / $407.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $44.67 / $60.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $407.38 / $489.78
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $426.58 / $467.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $398.11 / $691.83