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Utah rates for HCPCS 15775

Punch graft for hair transplant; 1 to 15 punch grafts

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $4,570.88 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $323.59 / $575.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $371.54 / $562.34
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $389.05
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $676.08 / $1,584.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $398.11 / $501.19
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $426.58 / $630.96
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $478.63 / $660.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $309.03 / $489.78