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Utah rates for HCPCS 15572

Formation of direct or tubed pedicle, with or without transfer; scalp, arms, or legs

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$773.70 / $3,294.00 / $7,568.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$557.60 / $773.70 / $1,324.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$763.48 / $1,034.43 / $1,388.34
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.32 / $503.12 / $813.75
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
$817.34 / $980.43 / $1,500.05
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
$711.18 / $910.81 / $1,341.90