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Utah rates for HCPCS 84081

Phosphatidylglycerol

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $112.20 / $147.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $12.88 / $19.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.13 / $14.45 / $45.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $19.05 / $31.62
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.60 / $60.26 / $87.10
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $14.13 / $14.79
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $16.60 / $52.48
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.45 / $16.60 / $24.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.32 / $8.32 / $10.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $9.77 / $22.91