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Utah rates for HCPCS 43502

Gastrotomy; with suture repair of pre-existing esophagogastric laceration (eg, Mallory-Weiss)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,659.59 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,949.84 / $3,162.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $60.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,511.89 / $3,235.94
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,818.38 / $3,890.45
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,238.72 / $3,090.30
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
$1,318.26 / $1,698.24 / $2,691.53