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Utah rates for HCPCS 15760

Graft Composite W/Primary Closure Donor Area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$750.85 / $2,744.00 / $4,626.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$542.91 / $750.85 / $1,283.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$763.35 / $1,001.40 / $1,332.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.32 / $503.12 / $772.56
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
$773.79 / $940.21 / $1,407.91
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
$696.96 / $871.20 / $1,400.11