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Utah rates for HCPCS 17004

Destruction Premalignant Lesion 15/>

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.05 / $822.18 / $4,291.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.63 / $153.84 / $351.74
Aetna
Facility/Professional
Professional
Modifier
22
Low / Median / High Price
$799.01 / $799.01 / $799.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.11 / $186.60 / $261.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.03 / $119.29 / $149.57
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$571.79 / $756.04 / $1,101.77
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.86 / $175.64 / $228.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,556.00 / $4,495.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.40 / $161.68 / $259.83