go back

Utah rates for HCPCS 43204

Esophagoscopy Flex Transoral Injection Varices

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.54 / $2,922.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.58 / $211.99 / $395.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.36 / $227.23 / $386.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.44 / $90.12 / $113.84
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,686.94 / $3,607.85 / $5,257.67
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.63 / $233.11 / $316.31
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
$126.68 / $198.69 / $289.36