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Utah rates for HCPCS 67515

Injection Medication/Other Subst Tenon Capsule

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.13 / $2,870.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.61 / $93.13 / $111.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.46 / $79.26 / $113.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.74 / $60.00 / $75.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$432.75 / $552.34 / $804.92
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$649.13 / $828.51 / $1,207.38
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.43 / $73.98 / $202.08
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
$58.79 / $85.55 / $120.56