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Utah rates for HCPCS 54111

Exc Penile Plaque Graft &/5 Cm Length

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,072.17 / $3,084.00 / $4,707.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,049.27 / $1,072.17 / $1,597.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$959.81 / $1,127.98 / $1,490.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.98 / $581.16 / $763.50
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,298.64 / $9,810.86 / $14,297.23
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,037.83 / $1,204.30 / $1,406.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $7,693.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$762.63 / $932.41 / $1,714.66