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Utah rates for HCPCS 69801

Labyrinthotomy, with perfusion of vestibuloactive drug(s), transcanal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $4,570.88 / $9,332.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $218.78 / $524.81
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$537.03 / $537.03 / $537.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $257.04 / $645.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $446.68
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,630.27 / $5,888.44
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $316.23 / $478.63
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $239.88 / $512.86
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $323.59 / $524.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $223.87 / $501.19