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Utah rates for HCPCS 53454

Periurethral transperineal adjustable balloon continence device; percutaneous adjustment of balloon(s) fluid volume

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.84 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $28.84 / $50.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $57.54 / $288.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $44.67 / $60.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $512.86 / $912.01
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $66.07 / $77.62
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $53.70 / $67.61
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $58.88 / $63.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $30.90 / $66.07