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Utah rates for HCPCS 15760

Graft; composite (eg, full thickness of external ear or nasal ala), including primary closure, donor area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $3,235.94 / $4,786.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $758.58 / $1,288.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,000.00 / $1,318.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,951.21
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $3,311.31 / $7,244.36
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,122.02 / $1,949.84
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,023.29 / $1,584.89
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,071.52 / $2,041.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $794.33 / $1,202.26