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Utah rates for HCPCS 15769

Grafting Of Autologous Soft Tiss By Direct Exc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$511.19 / $4,387.00 / $8,802.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$357.83 / $492.50 / $1,159.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.56 / $647.73 / $895.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.14 / $324.24 / $474.81
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
$520.87 / $593.67 / $736.72
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
$400.16 / $498.96 / $804.61