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Utah rates for HCPCS 12004

Simple Rpr Scalp/Neck/Ax/Genit/Trunk 7.6-12.5cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.19 / $384.36 / $4,293.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.58 / $128.36 / $225.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.91 / $160.25 / $226.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.11 / $90.31 / $112.17
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$297.07 / $379.59 / $553.17
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.18 / $136.97 / $198.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,556.00 / $4,495.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.54 / $133.28 / $206.80