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Utah rates for HCPCS 63746

Removal of entire lumbosubarachnoid shunt system without replacement

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $3,715.35 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $758.58 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $812.83 / $1,698.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,659.59
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $3,388.44 / $7,585.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,174.90 / $2,187.76
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,318.26 / $1,862.09
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,047.13 / $1,513.56
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
$489.78 / $630.96 / $1,000.00