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Utah rates for HCPCS 54115

Removal foreign body from deep penile tissue (eg, plastic implant)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $501.19 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $588.84 / $870.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $870.96
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,890.45 / $4,570.88 / $10,964.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $676.08 / $1,000.00
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $794.33 / $933.25
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $676.08 / $1,023.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $5,128.61 / $7,079.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $512.86 / $891.25