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Utah rates for HCPCS 39503

Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or without creation of ventral hernia

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $4,570.88 / $6,165.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $5,754.40 / $7,244.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $8,128.31 / $12,589.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $12,302.69
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,413.10 / $10,964.78 / $14,125.38
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $9,120.11 / $12,589.25
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,585.78 / $8,912.51 / $12,589.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,370.32 / $6,918.31 / $12,022.64