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Utah rates for HCPCS 30920

Ligation arteries; internal maxillary artery, transantral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $5,888.44 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $954.99 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,096.48 / $1,862.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,584.89
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,786.30 / $5,623.41 / $12,589.25
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,513.56 / $1,778.28
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,584.89 / $2,089.30
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,288.25 / $1,905.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,128.61 / $8,317.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $954.99 / $1,737.80