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Utah rates for HCPCS 41872

Gingivoplasty, each quadrant (specify)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $3,388.44 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $436.52 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $446.68 / $776.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $602.56
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $5,370.32 / $12,022.64
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $562.34 / $758.58
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $588.84 / $912.01
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $616.60 / $912.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $398.11 / $676.08