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Utah rates for HCPCS 69631

Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $6,165.95 / $15,135.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,230.27 / $4,786.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,174.90 / $1,905.46
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $2,041.74
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $10,000.00 / $22,387.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,445.44 / $1,698.24
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,584.89 / $2,137.96
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,348.96 / $1,905.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,000.00 / $1,819.70