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Utah rates for HCPCS 14301

Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$966.69 / $3,128.63 / $8,309.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$738.48 / $1,000.22 / $3,351.78
Aetna
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$61.79 / $624.02 / $640.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$962.61 / $1,287.51 / $1,703.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.31 / $647.44 / $1,017.75
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,537.58 / $6,904.89 / $9,912.95
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.25 / $1,202.57 / $1,750.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $6,097.00 / $8,267.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$871.56 / $1,110.97 / $1,676.60