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Utah rates for HCPCS 15120

Split Agrft F/S/N/H/F/G/M/D Gt 1st 100 Cm/</1 %

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$830.64 / $3,038.00 / $5,743.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.83 / $785.90 / $2,522.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.23 / $1,026.14 / $1,332.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.32 / $490.61 / $779.55
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
$764.94 / $939.47 / $1,393.90
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
$706.44 / $879.14 / $1,386.01