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Utah rates for HCPCS 42104

Exc Lesion Palate Uvula W/O Closure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.42 / $2,744.00 / $4,626.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.67 / $192.86 / $391.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.02 / $243.38 / $398.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.10 / $172.11 / $229.06
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,525.68 / $6,104.56 / $8,896.10
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.75 / $285.45 / $393.55
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
$187.22 / $277.20 / $446.41