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Utah rates for HCPCS 15100

Split Agrft T/A/L 1st 100 Cm/&/1% Bdy Inft/Chld

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$754.42 / $3,038.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.97 / $777.80 / $2,379.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$787.71 / $1,017.47 / $1,365.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.32 / $519.35 / $803.09
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,814.80 / $3,509.81 / $5,038.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$793.72 / $964.20 / $1,423.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,689.00 / $2,312.00 / $4,640.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$672.35 / $894.25 / $1,326.51