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Utah rates for HCPCS 31623

Brnchsc Brushing/Protected Brushings

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.43 / $3,038.00 / $5,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.12 / $288.92 / $401.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.91 / $323.54 / $503.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.95 / $227.90 / $292.38
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,475.05 / $3,218.11 / $4,689.71
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.11 / $357.26 / $591.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,689.00 / $2,312.00 / $4,640.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.78 / $358.01 / $568.35