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Utah rates for HCPCS 43634

Gstrct Prtl Dstl W/Frmj Intstinal Pouch

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,798.28 / $3,038.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,946.91 / $2,798.28 / $6,083.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,761.29 / $2,923.32 / $4,048.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.48 / $1,387.97 / $2,013.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,766.25 / $3,524.55 / $4,483.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,312.00 / $2,446.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.69 / $2,642.78 / $4,097.93