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Utah rates for HCPCS 43763

Perq Replacement Gtube Req Revj Gstrst Trc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.28 / $2,833.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.50 / $296.77 / $438.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.75 / $318.39 / $605.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.33 / $262.91 / $332.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$381.48 / $484.37 / $682.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.27 / $191.76 / $581.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,556.00 / $4,495.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.83 / $366.17 / $590.29