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Utah rates for HCPCS 19301

Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy);

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $6,456.54 / $9,120.11
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,623.41 / $5,623.41 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $812.83 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $870.96 / $1,445.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,548.82
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,248.07 / $6,165.95 / $14,454.40
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$7,762.47 / $9,120.11 / $21,877.62
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,148.15 / $1,513.56
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,380.38 / $1,659.59
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,071.52 / $1,445.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $5,128.61 / $7,079.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $724.44 / $1,380.38