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Utah rates for HCPCS 19301

Mastectomy Partial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,376.03 / $6,405.04 / $9,074.21
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,593.95 / $5,593.95 / $5,593.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$610.41 / $820.86 / $1,460.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$773.92 / $930.98 / $1,439.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.01 / $383.71 / $604.10
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,302.41 / $7,227.26 / $10,532.19
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$7,953.62 / $10,840.89 / $15,798.29
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$867.26 / $1,154.86 / $1,395.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,981.00 / $3,613.00 / $7,048.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.42 / $827.64 / $1,414.17