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Utah rates for HCPCS 43204

Esophagoscopy, flexible, transoral; with injection sclerosis of esophageal varices

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $154.88 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $245.47 / $426.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $380.19
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $3,162.28 / $7,413.10
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $229.09 / $316.23
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $316.23 / $426.58
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $199.53 / $309.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $169.82 / $288.40